Provider Demographics
NPI:1790761633
Name:NIEMANN, CARRIE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:S
Last Name:NIEMANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8471 RESOLUTE WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7381
Mailing Address - Country:US
Mailing Address - Phone:843-760-6565
Mailing Address - Fax:843-760-6484
Practice Address - Street 1:8471 RESOLUTE WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7381
Practice Address - Country:US
Practice Address - Phone:843-760-6565
Practice Address - Fax:843-760-6484
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist