Organization
COOSAW DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS NELSON PARE III (OWNER/DENTIST)
(843) 225-7614
Entity
Organization
Contact information
Practice address
8626 DORCHESTER RD STE 102, NORTH CHARLESTON, SC 29420-7328
(843) 225-7614
Mailing address
8626 DORCHESTER RD STE 102, NORTH CHARLESTON, SC 29420-7328
(843) 225-7614
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4650
SC
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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