| Organization Name: | VILLAGE DENTISTRY, PA |
| NPI Number: | 1679767073 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT W HAILE (PRESIDENT) |
| Mailing Address: | 130 Gardners Cir Pmb#131 Johns Island |
| State: | SC US |
| Postal Code: | 294555467 |
| Phone Number: | 8437688376 |
| Fax Number: | |
| NPI Enumeration Date: | 08/29/2007 |
| NPI Last Update Date: | 11/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 1688 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |