Provider Demographics
NPI:1205873114
Name:STRAUSS, EDWARD R (DMD MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:STRAUSS
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WAPPOO CREEK DR
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2135
Mailing Address - Country:US
Mailing Address - Phone:843-762-9028
Mailing Address - Fax:843-762-9030
Practice Address - Street 1:109 WAPPOO CREEK DR
Practice Address - Street 2:SUITE 2-B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2135
Practice Address - Country:US
Practice Address - Phone:843-762-9028
Practice Address - Fax:843-762-9030
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4006Medicaid
SCV05198Medicare UPIN
SCZX4006Medicaid