Provider Demographics
NPI:1669680948
Name:EAST COOPER DENTAL EXCELLENCE
Entity Type:Organization
Organization Name:EAST COOPER DENTAL EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-388-9894
Mailing Address - Street 1:1100 QUEENSBOROUGH BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-388-9894
Mailing Address - Fax:843-388-9896
Practice Address - Street 1:1100 QUEENSBOROUGH BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-388-9894
Practice Address - Fax:843-388-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2162122300000X
SC3884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty