Provider Demographics
NPI:1598959777
Name:CHARLES BUIST DMD PA
Entity Type:Organization
Organization Name:CHARLES BUIST DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-284-2884
Mailing Address - Street 1:32 OFFICE PARK RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4637
Mailing Address - Country:US
Mailing Address - Phone:843-842-2884
Mailing Address - Fax:
Practice Address - Street 1:32 OFFICE PARK RD
Practice Address - Street 2:SUITE 207
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4637
Practice Address - Country:US
Practice Address - Phone:843-842-2884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty