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Organization
TEETH DS ISLE OF PALMS
Active
Organization
TEETH DS ISLE OF PALMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUKE LISZKA DMD (OWNER)
(843) 886-6461
Entity
Organization
Contact information
Practice address
15 21ST AVE, ISLE OF PALMS, SC 29451-2384
(843) 886-6461
(843) 886-3957
Mailing address
PO BOX 347, ISLE OF PALMS, SC 29451-0347
(843) 886-6461
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9325
DENTAL
SC
Enumeration date
10/26/2020
Last updated
10/26/2020
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