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Dental Public Health

Summerville, South Carolina

Provider NPI: 1992862742

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 843-871-0842  Fax: 843-832-4531

Business Mailing Address:
Tel: 843-871-0842  Fax: 843-832-4531

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223D0001XDental Providers
Dental Public Health

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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