Provider Demographics
NPI:1508287863
Name:CROWFIELD AT NORTH CHARLESTON, LLC
Entity Type:Organization
Organization Name:CROWFIELD AT NORTH CHARLESTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-797-7200
Mailing Address - Street 1:8310 RIVERS AVE
Mailing Address - Street 2:SUITE D
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:843-797-8293
Practice Address - Street 1:8310 RIVERS AVE
Practice Address - Street 2:SUITE D
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:843-797-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty