Organization
INDIAN LAND ORAL & FACIAL SURGERY LLC
Active
Other names
Greater Charlotte Oral & Facial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY COYNER (CREDENTIALING)
(304) 720-7819
Entity
Organization
Contact information
Practice address
9787 CHARLOTTE HWY, FORT MILL, SC 29707-8103
(980) 939-1400
Mailing address
9789 CHARLOTTE HWY STE 400-207, FORT MILL, SC 29707-7177
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
06/15/2018
Last updated
06/15/2018
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