Provider Demographics
NPI:1821248394
Name:AIKEN ENDODONTICS
Entity Type:Organization
Organization Name:AIKEN ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-649-1771
Mailing Address - Street 1:105 SUMMERWOOD WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7713
Mailing Address - Country:US
Mailing Address - Phone:803-649-1771
Mailing Address - Fax:803-641-1311
Practice Address - Street 1:105 SUMMERWOOD WAY
Practice Address - Street 2:SUITE C
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7713
Practice Address - Country:US
Practice Address - Phone:803-649-1771
Practice Address - Fax:803-641-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4402261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental