Organization
SOUTHERN OAK DENTAL, LLC
Active
Other names
Dental Home EB5 VII
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK GONG (OWNER)
(206) 371-2516
Entity
Organization
Contact information
Practice address
1322 BROAD ST UNIT 90, SUMTER, SC 29150-1984
(912) 856-9698
Mailing address
4921 CENTRE POINTE DR STE 201, NORTH CHARLESTON, SC 29418-6997
(912) 856-9698
(843) 781-7403
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/15/2020
Last updated
05/15/2020
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