Provider Demographics
NPI:1881080844
Name:B. ANDREW GAME, DMD, LLC
Entity type:Organization
Organization Name:B. ANDREW GAME, DMD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GAME
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-203-5429
Mailing Address - Street 1:3750 SAVANNAH HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-7909
Mailing Address - Country:US
Mailing Address - Phone:843-779-6061
Mailing Address - Fax:
Practice Address - Street 1:3750 SAVANNAH HWY
Practice Address - Street 2:SUITE B AND C
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-7909
Practice Address - Country:US
Practice Address - Phone:843-779-6061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty