Organization
SC SOUTHERN DENTAL PC
Active
Parent organization
SC SOUTHERN DENTAL PC
Other names
James Island Family, Cosmetic and Implant Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
SC SOUTHERN DENTAL PC
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
531 FOLLY RD, CHARLESTON, SC 29412-3007
(843) 795-1111
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/22/2024
Last updated
10/22/2024
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