Individual
DR. JOHN C. ELIASSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
719 OKATIE HWY # 170, OKATIE, SC 29909-3963
(843) 987-7400
Mailing address
812 10TH ST, PORT ROYAL, SC 29935-2422
(843) 521-7733
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8167
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8167
—
SC
Enumeration date
07/04/2006
Last updated
03/10/2020
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