Provider Demographics
NPI:1497361307
Name:CANE BAY FAMILY DENTISTRY - GOOSE CREEK LLC
Entity Type:Organization
Organization Name:CANE BAY FAMILY DENTISTRY - GOOSE CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:DENAE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-352-4454
Mailing Address - Street 1:129 PLANTATION NORTH BLVD
Mailing Address - Street 2:UNIT D
Mailing Address - City:GOOSECREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445
Mailing Address - Country:US
Mailing Address - Phone:843-410-4920
Mailing Address - Fax:843-410-4924
Practice Address - Street 1:129 PLANTATION NORTH BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:GOOSECREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2944
Practice Address - Country:US
Practice Address - Phone:843-410-4920
Practice Address - Fax:843-410-4924
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANE BAY FAMILY DENTISTRY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty