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Organization
SOUTHERN OAK DENTAL, LLC
Active
Organization
SOUTHERN OAK DENTAL, LLC
Active
Other names
Dental Home EB5 VII
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK GONG (OWNER)
(206) 371-2516
Entity
Organization
Contact information
Practice address
1322 BROAD ST UNIT 90, SUMTER, SC 29150-1984
(912) 856-9698
Mailing address
4921 CENTRE POINTE DR STE 201, NORTH CHARLESTON, SC 29418-6997
(912) 856-9698
(843) 781-7403
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/15/2020
Last updated
05/15/2020
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