Provider Demographics
NPI:1265930697
Name:PALMETTO OFS, LLC
Entity type:Organization
Organization Name:PALMETTO OFS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:864-714-1800
Mailing Address - Street 1:3021 AMBERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8125
Mailing Address - Country:US
Mailing Address - Phone:864-420-2738
Mailing Address - Fax:
Practice Address - Street 1:2849 N PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3034
Practice Address - Country:US
Practice Address - Phone:864-714-1800
Practice Address - Fax:864-714-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8374204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty