Organization
CHILDREN'S DENTAL CLINIC OF CHARLESTON, LLC
Active
Parent organization
CHILDREN'S DENTAL CLINIC OF CHARLESTON, LLC
Other names
Children's Wellness Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S DENTAL CLINIC OF CHARLESTON, LLC
Authorized official
MRS. JEANEAN S. FOSTER (DIRECTOR, LICENSING & CREDENTIALING)
(615) 750-0342
Entity
Organization
Contact information
Practice address
6035 RIVERS AVE STE A, NORTH CHARLESTON, SC 29406-5018
(843) 572-9909
(843) 572-9901
Mailing address
618 CHURCH ST, SUITE 520, NASHVILLE, TN 37219-2428
(615) 750-0342
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
SC
Enumeration date
07/21/2011
Last updated
07/21/2011
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