Provider Demographics
NPI:1033328620
Name:AL IVESTER,DMD,PA
Entity Type:Organization
Organization Name:AL IVESTER,DMD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:IVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-971-8668
Mailing Address - Street 1:176 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7539
Mailing Address - Country:US
Mailing Address - Phone:843-216-0419
Mailing Address - Fax:
Practice Address - Street 1:636 LONG POINT RD UNIT F
Practice Address - Street 2:BELLE HALL SHOPPING CENTER
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8286
Practice Address - Country:US
Practice Address - Phone:843-971-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty