Organization
SOUTHERN OAK DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANK GONG (OWNER)
(206) 371-2940
Entity
Organization
Contact information
Practice address
101 VERDAE BLVD STE 201, GREENVILLE, SC 29607-3832
(864) 587-7155
Mailing address
4921 CENTRE POINTE DR STE 201, N CHARLESTON, SC 29418-6997
(843) 459-8780
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/04/2019
Last updated
01/30/2020
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