Organization
SOLOMON KIDS PEDIATRIC DENTISTRY KNIGHTSVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA MARIE BAZZLE (OPERATION MANAGER)
(843) 871-0842
Entity
Organization
Contact information
Practice address
491 W BUTTERNUT RD, SUMMERVILLE, SC 29483-5507
(843) 871-0842
Mailing address
1971 N MAIN ST, SUMMERVILLE, SC 29486-7820
(843) 871-0842
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8526
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8227
—
SC
05
—
ZX8526
—
SC
Enumeration date
07/20/2017
Last updated
07/20/2017
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