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Organization

ELLIS OAKS DENTAL CENTER LLC

Active
Other names
Christy M Fogle DMD
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TERESA E WILSON (OFFICE MANAGER)
(843) 762-2065
Entity
Organization

Contact information

Practice address
776 DANIEL ELLIS DRIVE, SUITE 3A, CHARLESTON, SC 29412
(843) 762-2065
(843) 762-7735
Mailing address
PO BX 12290, CHARLESTON, SC 29422-2290
(843) 762-2065
(843) 762-7735

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2406
SC
261QD0000X
Dental Clinic/Center
2406
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
Z9A9837
SC
05
ZA9837
SC
Enumeration date
11/14/2006
Last updated
09/11/2025
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