Provider Demographics
NPI:1740568765
Name:MOUTH CAROLINA DENTISTRY, PA
Entity type:Organization
Organization Name:MOUTH CAROLINA DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-260-4592
Mailing Address - Street 1:3 GAMECOCK AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3378
Mailing Address - Country:US
Mailing Address - Phone:843-556-4798
Mailing Address - Fax:843-556-4798
Practice Address - Street 1:3 GAMECOCK AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3378
Practice Address - Country:US
Practice Address - Phone:843-556-4798
Practice Address - Fax:843-556-4798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty