Provider Demographics
NPI:1508318932
Name:CHARLESTON ORTHODONTIC SPECIALISTS, INC
Entity Type:Organization
Organization Name:CHARLESTON ORTHODONTIC SPECIALISTS, INC
Other - Org Name:CHARLESTON ORTHODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-642-8100
Mailing Address - Street 1:975 SAVANNAH HWY
Mailing Address - Street 2:107B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7859
Mailing Address - Country:US
Mailing Address - Phone:843-642-8100
Mailing Address - Fax:
Practice Address - Street 1:975 SAVANNAH HWY
Practice Address - Street 2:107B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7859
Practice Address - Country:US
Practice Address - Phone:843-642-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty