Provider Demographics
NPI:1760834949
Name:CANE BAY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CANE BAY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-352-4454
Mailing Address - Street 1:1724 STATE RD UNIT 4D
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-2842
Mailing Address - Country:US
Mailing Address - Phone:843-352-4454
Mailing Address - Fax:843-352-4875
Practice Address - Street 1:1724 STATE RD UNIT 4D
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-2842
Practice Address - Country:US
Practice Address - Phone:843-352-4454
Practice Address - Fax:843-352-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1295045771OtherSTATE
SC1366858870OtherSTATE
SC1396110078OtherSTATE
SC1710969845OtherSTATE
SC1982056966OtherSTATE