Provider Demographics
NPI:1669537833
Name:CUSPIDS, INCORPORATED
Entity type:Organization
Organization Name:CUSPIDS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-767-3300
Mailing Address - Street 1:3796 ASHLEY PHOSPHATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8560
Mailing Address - Country:US
Mailing Address - Phone:843-767-3300
Mailing Address - Fax:843-207-1627
Practice Address - Street 1:3796 ASHLEY PHOSPHATE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8560
Practice Address - Country:US
Practice Address - Phone:843-767-3300
Practice Address - Fax:843-207-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Not Answered126800000XDental ProvidersDental AssistantGroup - Single Specialty
Not Answered126900000XDental ProvidersDental Laboratory TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZZ2580Medicaid