Provider Demographics
NPI:1922569656
Name:FAMILY LASER DENTAL OF NORTH CHARLESTON LLC
Entity Type:Organization
Organization Name:FAMILY LASER DENTAL OF NORTH CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DR NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-642-8100
Mailing Address - Street 1:7455 CROSS COUNTY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8470
Mailing Address - Country:US
Mailing Address - Phone:843-552-4771
Mailing Address - Fax:
Practice Address - Street 1:7455 CROSS COUNTY RD STE 4
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8470
Practice Address - Country:US
Practice Address - Phone:843-552-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty