Provider Demographics
NPI:1336302363
Name:OLIPHANT, ALBERT DRANE IV (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:DRANE
Last Name:OLIPHANT
Suffix:IV
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 WAPPOO CREEK DR # C
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2163
Mailing Address - Country:US
Mailing Address - Phone:843-762-9028
Mailing Address - Fax:843-762-9030
Practice Address - Street 1:125 WAPPOO CREEK DR # C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2163
Practice Address - Country:US
Practice Address - Phone:843-762-9028
Practice Address - Fax:843-762-9030
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8500122300000X
SC71251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist