# WENTWORTH STREET DENTAL ASSOCIATES, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598088312
- **Authorized official:** DR. ROGERS CONYERS REEVES D.M.D. (C.E.O.)
- **Authorized official phone:** (843) 577-2898

## Contact information

- **Practice address:** 159 WENTWORTH ST, CHARLESTON, SC 29401-6715
- **Practice address phone:** (843) 577-2898
- **Practice address fax:** (843) 577-4464
- **Mailing address:** 159 WENTWORTH ST, CHARLESTON, SC 29401-6715
- **Mailing address phone:** (843) 577-2898
- **Mailing address fax:** (843) 577-4464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 1547 | SC | Yes |

## Other

- **Enumeration date:** 03/08/2010
- **Last updated:** 03/08/2010