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Organization
WENTWORTH STREET DENTAL ASSOCIATES, INC
Active
Organization
WENTWORTH STREET DENTAL ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGERS CONYERS REEVES D.M.D. (C.E.O.)
(843) 577-2898
Entity
Organization
Contact information
Practice address
159 WENTWORTH ST, CHARLESTON, SC 29401-6715
(843) 577-2898
(843) 577-4464
Mailing address
159 WENTWORTH ST, CHARLESTON, SC 29401-6715
(843) 577-2898
(843) 577-4464
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
1547
SC
Other
Enumeration date
03/08/2010
Last updated
03/08/2010
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