# TRIDENT DENTAL ASSOCIATES, LLC

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

## Provider details

- **NPI number:** 1053083154
- **Authorized official:** WILLIAM TEDERICK JOHNSON (GROUP VICE PRESIDENT/AO)
- **Authorized official phone:** (615) 372-3375

## Contact information

- **Practice address:** 9228 MEDICAL PLAZA DR, CHARLESTON, SC 29406-9125
- **Practice address phone:** (843) 574-5693
- **Practice address fax:** (843) 764-4512
- **Mailing address:** 2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4692
- **Mailing address phone:** (615) 373-7406
- **Mailing address fax:** (866) 346-1426

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 09/28/2021
- **Last updated:** 08/29/2023