Provider Demographics
NPI:1740326164
Name:LOWCOUNTRY DENTAL IMPLANT & PERIODONTICS CENTER,LLC
Entity type:Organization
Organization Name:LOWCOUNTRY DENTAL IMPLANT & PERIODONTICS CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:KRESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-525-6264
Mailing Address - Street 1:1002 BAY ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5570
Mailing Address - Country:US
Mailing Address - Phone:843-525-6264
Mailing Address - Fax:843-522-8967
Practice Address - Street 1:1002 BAY ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5570
Practice Address - Country:US
Practice Address - Phone:843-525-6264
Practice Address - Fax:843-522-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty