Provider Demographics
NPI:1902221757
Name:WEST ASHLEY FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:WEST ASHLEY FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DICKERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-571-7951
Mailing Address - Street 1:811 SAINT ANDREWS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7187
Mailing Address - Country:US
Mailing Address - Phone:843-571-7951
Mailing Address - Fax:843-571-7952
Practice Address - Street 1:811 SAINT ANDREWS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7187
Practice Address - Country:US
Practice Address - Phone:843-571-7951
Practice Address - Fax:843-571-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty