Organization
ARCHDALE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK M. CONDREY JR. DMD (DENTIST)
(843) 552-1600
Entity
Organization
Contact information
Practice address
5306 PARKSHIRE WAY, NORTH CHARLESTON, SC 29418-2000
(843) 552-1600
(843) 552-0049
Mailing address
5306 PARKSHIRE WAY, NORTH CHARLESTON, SC 29418-2000
(843) 552-1600
(843) 552-0049
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX2785
—
SC
Enumeration date
11/19/2012
Last updated
11/19/2012
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