Provider Demographics
NPI:1275611659
Name:JAMES ISLAND DENTAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:JAMES ISLAND DENTAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-762-1234
Mailing Address - Street 1:113 WAPPOO CREEK DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-762-1234
Mailing Address - Fax:843-762-9142
Practice Address - Street 1:113 WAPPOO CREEK DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-762-1234
Practice Address - Fax:843-762-9142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty