Organization
CHARLESTON FACIAL PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID WASTSON RODWELL III M.D. (OWNER)
(843) 882-7181
Entity
Organization
Contact information
Practice address
67 BROAD ST, SUITE 200, CHARLESTON, SC 29401-2936
(843) 882-7181
Mailing address
281 E SHORE LN, CHARLESTON, SC 29407-5656
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
TL36529
SC
Other
Enumeration date
04/15/2014
Last updated
04/15/2014
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