Organization
LOCKWOOD DENTAL ASSCOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG STEVEN MODZELEWSKI DMD (OWNER)
(843) 722-8500
Entity
Organization
Contact information
Practice address
14 LOCKWOOD DRIVE, STE A, CHARLESTON, SC 29401
(843) 722-8500
(843) 720-8555
Mailing address
14 LOCKWOOD DRIVE, STE A, CHARLESTON, SC 29401
(843) 722-8500
(843) 720-8555
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1313
SC
1223G0001X
General Practice Dentistry
3892
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z13138
—
SC
05
—
ZX3892
—
SC
Enumeration date
04/18/2007
Last updated
08/22/2020
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