Organization
CHARLESTON PEDIATRIC DENTISTRY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BODIFORD (OFFICE MANAGER)
(843) 797-5133
Entity
Organization
Contact information
Practice address
9217 UNIVERSITY BLVD STE 1C, NORTH CHARLESTON, SC 29406-9147
(843) 797-5133
(843) 797-5865
Mailing address
9217 UNIVERSITY BLVD STE 1C, NORTH CHARLESTON, SC 29406-9147
(843) 797-5133
(843) 797-5865
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2638-0358 SC
SC
Other
Enumeration date
03/28/2007
Last updated
08/22/2020
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