Organization
REDBANK FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SERGE GAUTHIER DDS (OWNER)
(404) 451-4888
Entity
Organization
Contact information
Practice address
513 RED BANK RD, GOOSE CREEK, SC 29445-4507
(843) 797-1161
(843) 797-1162
Mailing address
PO BOX 158, GOOSE CREEK, SC 29445-0158
(843) 797-1161
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7059
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX7059
—
SC
Enumeration date
06/29/2015
Last updated
08/21/2015
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