Organization
TRIDENT DERMATOLOGY, PA
Active
Other names
Trident Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
BLAKE AARON GUINN (PRACTICE MANAGER)
(843) 797-3960
Entity
Organization
Contact information
Practice address
9295 MEDICAL PLAZA DR, B, CHARLESTON, SC 29406-9137
(843) 797-3960
Mailing address
9295 MEDICAL PLAZA DR, B, CHARLESTON, SC 29406-9137
(843) 797-3960
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
10773
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK8300
MEDICARE RAILROAD
SC
05
—
PA5761
—
SC
Enumeration date
04/04/2006
Last updated
08/14/2023
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