Provider Demographics
NPI:1225708373
Name:OLD TROLLEY DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:OLD TROLLEY DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KIBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-871-2971
Mailing Address - Street 1:600 OLD TROLLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5686
Mailing Address - Country:US
Mailing Address - Phone:843-871-2971
Mailing Address - Fax:843-871-7412
Practice Address - Street 1:600 OLD TROLLEY RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5686
Practice Address - Country:US
Practice Address - Phone:843-871-2971
Practice Address - Fax:843-871-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty