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Organization
CRANE FAMILY DENTISTRY LLC
Active
Organization
CRANE FAMILY DENTISTRY LLC
Active
Other names
Nicklas Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES EDWARD CRANE III DMD (MEMBER)
(803) 807-0060
Entity
Organization
Contact information
Practice address
9565 HIGHWAY 78 BLDG 600B, LADSON, SC 29456-4116
(843) 412-4036
Mailing address
9565 HIGHWAY 78 BLDG 600B, LADSON, SC 29456-4116
(843) 412-4036
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX9205
—
SC
Enumeration date
12/31/2020
Last updated
12/31/2020
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