# CHARLESTON PEDIATRIC DENTISTRY, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033238589
- **Authorized official:** LISA BODIFORD (OFFICE MANAGER)
- **Authorized official phone:** (843) 797-5133

## Contact information

- **Practice address:** 9217 UNIVERSITY BLVD STE 1C, NORTH CHARLESTON, SC 29406-9147
- **Practice address phone:** (843) 797-5133
- **Practice address fax:** (843) 797-5865
- **Mailing address:** 9217 UNIVERSITY BLVD STE 1C, NORTH CHARLESTON, SC 29406-9147
- **Mailing address phone:** (843) 797-5133
- **Mailing address fax:** (843) 797-5865

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 2638-0358 SC | SC | Yes |

## Other

- **Enumeration date:** 03/28/2007
- **Last updated:** 08/22/2020