Organization
SOUTHEAST ENDODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER R. LONG D.M.D. (OWNER)
(843) 766-0112
Entity
Organization
Contact information
Practice address
10 FARMFIELD AVE, CHARLESTON, SC 29407-7756
(843) 766-0112
(843) 766-0884
Mailing address
10 E FARMFIELD AVENUE, CHARLESTON, SC 29407
(843) 766-0112
(843) 766-0884
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
3707
SC
Other
Enumeration date
05/08/2007
Last updated
08/22/2020
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