Organization
RAYMOND S VICENTE DMD LLC
Active
Other names
Northside Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND S VICENTE DMD (DENTIST OWNER)
(843) 863-8634
Entity
Organization
Contact information
Practice address
7481 NORTHSIDE DRIVE, SUITE A, NORTH CHARLESTON, SC 29420-4282
(843) 863-8634
(843) 863-8242
Mailing address
7481 NORTHSIDE DRIVE, SUITE A, NORTH CHARLESTON, SC 29420-4282
(843) 863-8634
(843) 863-8242
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
SC3976
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9568
—
SC
Enumeration date
11/30/2007
Last updated
11/30/2007
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