Organization Name: | SMILEOLOGY DENTAL CLINIC, LLC |
NPI Number: | 1083017867 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TRACY M PAGE (CEO) |
Mailing Address: | 6518 Dorchester Rd Suite A N Charleston |
State: | SC US |
Postal Code: | 294185100 |
Phone Number: | 8437678555 |
Fax Number: | |
NPI Enumeration Date: | 10/07/2014 |
NPI Last Update Date: | 10/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 4691 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |