Provider Demographics
NPI:1629415674
Name:KIDZ PLANET PEDIATRIC DENTISTRY, PA
Entity Type:Organization
Organization Name:KIDZ PLANET PEDIATRIC DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:SWASTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:843-405-4463
Mailing Address - Street 1:494 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7275
Mailing Address - Country:US
Mailing Address - Phone:843-405-4463
Mailing Address - Fax:843-879-9155
Practice Address - Street 1:494 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7275
Practice Address - Country:US
Practice Address - Phone:843-405-4463
Practice Address - Fax:843-879-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty