Provider Demographics
NPI:1407113848
Name:NORTH CHARLESTON DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTH CHARLESTON DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-573-9255
Mailing Address - Street 1:8310 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9268
Mailing Address - Country:US
Mailing Address - Phone:843-797-7200
Mailing Address - Fax:
Practice Address - Street 1:8310 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9268
Practice Address - Country:US
Practice Address - Phone:843-797-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty