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Organization
CHARLESTON JAW SURGERY
Active
Organization
CHARLESTON JAW SURGERY
Active
Parent organization
SHELBOURNE & ASSOCIATES ORAL & FACIAL SURGERY
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHELBOURNE & ASSOCIATES ORAL & FACIAL SURGERY
Authorized official
ROBERT BENNETT (BUSINESS MANAGER)
(843) 853-5859
Entity
Organization
Contact information
Practice address
846 ST. ANDREWS BLVD., CHARLESTON, SC 29407
(843) 853-5859
(843) 853-5861
Mailing address
846 ST. ANDREWS BLVD., CHARLESTON, SC 29407
(843) 853-5859
(843) 853-5861
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
09/04/2020
Last updated
09/04/2020
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