Provider Demographics
NPI:1841638376
Name:BLUFFTON CENTER FOR DENTISTRY
Entity type:Organization
Organization Name:BLUFFTON CENTER FOR DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:PORCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-441-8852
Mailing Address - Street 1:29 PLANTATION PARK DR
Mailing Address - Street 2:STE#303,304
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9001
Mailing Address - Country:US
Mailing Address - Phone:843-593-8123
Mailing Address - Fax:
Practice Address - Street 1:29 PLANTATION PARK DR
Practice Address - Street 2:STE#303,304
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9001
Practice Address - Country:US
Practice Address - Phone:843-593-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8083261QD0000X
SC4659261QD0000X
SC1985261QD0000X
SC4530261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental