Organization
CRANE FAMILY DENTISTRY LLC
Active
Other names
Nicklas Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES EDWARD CRANE III DMD (MEMBER)
(803) 807-0060
Entity
Organization
Contact information
Practice address
9565 HIGHWAY 78 BLDG 600B, LADSON, SC 29456-4116
(843) 412-4036
Mailing address
9565 HIGHWAY 78 BLDG 600B, LADSON, SC 29456-4116
(843) 412-4036
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX9205
—
SC
Enumeration date
12/31/2020
Last updated
12/31/2020
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