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Organization

TRIDENT DENTAL ASSOCIATES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WILLIAM TEDERICK JOHNSON (GROUP VICE PRESIDENT/AO)
(615) 372-3375
Entity
Organization

Contact information

Practice address
9228 MEDICAL PLAZA DR, CHARLESTON, SC 29406-9125
(843) 574-5693
(843) 764-4512
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4692
(615) 373-7406
(866) 346-1426

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary

Other

Enumeration date
09/28/2021
Last updated
08/29/2023
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