Provider Demographics
NPI:1275070070
Name:FAMILY LASER DENTAL OF NORTH CHARLESTON
Entity Type:Organization
Organization Name:FAMILY LASER DENTAL OF NORTH CHARLESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:IENI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-236-9770
Mailing Address - Street 1:4245 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7161
Mailing Address - Country:US
Mailing Address - Phone:603-236-9770
Mailing Address - Fax:
Practice Address - Street 1:7455 CROSS COUNTY RD
Practice Address - Street 2:UNIT 5
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8470
Practice Address - Country:US
Practice Address - Phone:843-552-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty