Provider Demographics
NPI:1205894474
Name:CHILDREN'S DENTISTRY, PA
Entity type:Organization
Organization Name:CHILDREN'S DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-797-1118
Mailing Address - Street 1:7465 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-4209
Mailing Address - Country:US
Mailing Address - Phone:843-797-5400
Mailing Address - Fax:843-797-5164
Practice Address - Street 1:7465 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4209
Practice Address - Country:US
Practice Address - Phone:843-797-5400
Practice Address - Fax:843-797-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9998Medicaid