Provider Demographics
NPI:1184211260
Name:ASSEY DENTAL CLINIC
Entity Type:Organization
Organization Name:ASSEY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-884-6004
Mailing Address - Street 1:1041 JOHNNIE DODDS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6156
Mailing Address - Country:US
Mailing Address - Phone:843-884-6004
Mailing Address - Fax:843-881-3850
Practice Address - Street 1:1041 JOHNNIE DODDS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6156
Practice Address - Country:US
Practice Address - Phone:843-884-6004
Practice Address - Fax:843-881-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty