Provider Demographics
NPI:1952517161
Name:MUSC COLLEGE OF DENTAL MEDICINE
Entity Type:Organization
Organization Name:MUSC COLLEGE OF DENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN FOR CLINICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-792-2142
Mailing Address - Street 1:173 ASHLEY AVE
Mailing Address - Street 2:BSB 246
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-0001
Mailing Address - Country:US
Mailing Address - Phone:843-792-2142
Mailing Address - Fax:843-792-3611
Practice Address - Street 1:173 ASHLEY AVE
Practice Address - Street 2:BSB 246
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0001
Practice Address - Country:US
Practice Address - Phone:843-792-2142
Practice Address - Fax:843-792-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC-3198261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental