Provider Demographics
NPI:1255651469
Name:DANIEL ISLAND DENTISTRY, LLC
Entity Type:Organization
Organization Name:DANIEL ISLAND DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-881-4545
Mailing Address - Street 1:210 SEVEN FARMS DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7561
Mailing Address - Country:US
Mailing Address - Phone:843-881-4545
Mailing Address - Fax:843-881-6252
Practice Address - Street 1:210 SEVEN FARMS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7561
Practice Address - Country:US
Practice Address - Phone:843-881-4545
Practice Address - Fax:843-881-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty