Provider Demographics
NPI:1679883524
Name:COMPREHENSIVE DENTISTRY FOR ADULTS
Entity Type:Organization
Organization Name:COMPREHENSIVE DENTISTRY FOR ADULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-797-6919
Mailing Address - Street 1:7465 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-4209
Mailing Address - Country:US
Mailing Address - Phone:843-797-6919
Mailing Address - Fax:
Practice Address - Street 1:7465 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4209
Practice Address - Country:US
Practice Address - Phone:843-797-6919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30-33821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9834Medicaid