# SOLOMON KIDS PEDIATRIC DENTISTRY KNIGHTSVILLE LLC

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

## Provider details

- **NPI number:** 1770006876
- **Authorized official:** MRS. ANGELA MARIE BAZZLE (OPERATION MANAGER)
- **Authorized official phone:** (843) 871-0842

## Contact information

- **Practice address:** 491 W BUTTERNUT RD, SUMMERVILLE, SC 29483-5507
- **Practice address phone:** (843) 871-0842
- **Mailing address:** 1971 N MAIN ST, SUMMERVILLE, SC 29486-7820
- **Mailing address phone:** (843) 871-0842

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 8526 | SC | Yes |

## Other

- **Enumeration date:** 07/20/2017
- **Last updated:** 07/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZX8227 | — | SC |
| 05 | — | ZX8526 | — | SC |