Provider Demographics
NPI:1508598384
Name:CAROLINA ELITE DENTAL
Entity Type:Organization
Organization Name:CAROLINA ELITE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-660-3432
Mailing Address - Street 1:11 CUNNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-9312
Mailing Address - Country:US
Mailing Address - Phone:912-660-3432
Mailing Address - Fax:
Practice Address - Street 1:KINGSTON VILLAGE DENTISTRY
Practice Address - Street 2:900 A MAIN STREET
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-2952
Practice Address - Country:US
Practice Address - Phone:843-488-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA ELITE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty