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Organization
SOLOMON KIDS PEDIATRIC DENTISTRY KNIGHTSVILLE LLC
Active
Organization
SOLOMON KIDS PEDIATRIC DENTISTRY KNIGHTSVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA MARIE BAZZLE (OPERATION MANAGER)
(843) 871-0842
Entity
Organization
Contact information
Practice address
491 W BUTTERNUT RD, SUMMERVILLE, SC 29483-5507
(843) 871-0842
Mailing address
1971 N MAIN ST, SUMMERVILLE, SC 29486-7820
(843) 871-0842
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8526
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8227
—
SC
05
—
ZX8526
—
SC
Enumeration date
07/20/2017
Last updated
07/20/2017
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