Provider Demographics
NPI:1508280991
Name:COMPREHENSIVE DENTISTRY FOR ADULTS INC
Entity Type:Organization
Organization Name:COMPREHENSIVE DENTISTRY FOR ADULTS INC
Other - Org Name:COMPREHENSIVE DENTISTRY FOR ADULTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-556-9939
Mailing Address - Street 1:1470 TOBIAS GADSON BLVD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4707
Mailing Address - Country:US
Mailing Address - Phone:843-556-9939
Mailing Address - Fax:843-769-6625
Practice Address - Street 1:1470 TOBIAS GADSON BLVD
Practice Address - Street 2:SUITE 100B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4707
Practice Address - Country:US
Practice Address - Phone:843-556-9939
Practice Address - Fax:843-769-6625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:17131
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3382122300000X
SC6898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9834Medicaid
SC1679883524OtherGROUP NPI