Provider Demographics
NPI:1710175914
Name:FAMILY AND RESTORATIVE DENTAL ASSOCIATES
Entity type:Organization
Organization Name:FAMILY AND RESTORATIVE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KANDL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-883-9529
Mailing Address - Street 1:2213 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVANS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29482-8780
Mailing Address - Country:US
Mailing Address - Phone:843-883-9529
Mailing Address - Fax:
Practice Address - Street 1:2213 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:SULLIVANS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29482-8780
Practice Address - Country:US
Practice Address - Phone:843-883-9529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3579261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental