Organization
MUSCDENTAL FACULTY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP J. BLACKLOCKE (BUSINESS MANAGER)
(843) 792-8330
Entity
Organization
Contact information
Practice address
173 ASHLEY AVE, BSB 346, CHARLESTON, SC 29425-0001
(843) 792-3444
(843) 792-0348
Mailing address
173 ASHLEY AVE, BSB 346, CHARLESTON, SC 29425-0001
(843) 792-3444
(843) 792-0348
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
SC
Other
Enumeration date
03/27/2007
Last updated
08/22/2020
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