Organization
PARK CIRCLE ORTHODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER VON BARGEN DDS (OWNER)
(585) 261-7414
Entity
Organization
Contact information
Practice address
4831 MIXSON AVE STE 104, NORTH CHARLESTON, SC 29405-4567
(843) 874-3136
Mailing address
4831 MIXSON AVE STE 104, NORTH CHARLESTON, SC 29405-4567
(843) 874-3136
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
03/02/2023
Last updated
03/02/2023
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