Provider Demographics
NPI:1679665830
Name:PARKWOOD DENTAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:PARKWOOD DENTAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:RUTLEDGE
Authorized Official - Last Name:SANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-571-6795
Mailing Address - Street 1:1247A SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7826
Mailing Address - Country:US
Mailing Address - Phone:843-571-6795
Mailing Address - Fax:843-556-7309
Practice Address - Street 1:1247A SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7826
Practice Address - Country:US
Practice Address - Phone:843-571-6795
Practice Address - Fax:843-556-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty