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Organization
WRMDSV III
Active
Organization
WRMDSV III
Active
Other names
MOD Aesthetics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R DEFEE DMD, PHD (DENTIST)
(843) 216-3484
Entity
Organization
Contact information
Practice address
320 BROAD ST # 210, CHARLESTON, SC 29401-1648
(843) 216-3484
Mailing address
320 BROAD ST # 210, CHARLESTON, SC 29401-1648
(843) 216-3484
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/07/2022
Last updated
07/07/2022
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