Organization
GOOSE CREEK DENTAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON THOMAS BARGANIER D.M.D (OWNER)
(843) 553-5235
Entity
Organization
Contact information
Practice address
100 BERKELEY SQUARE LN, GOOSE CREEK, SC 29445-2958
(843) 553-5235
Mailing address
PO BOX 1120, GOOSE CREEK, SC 29445-1120
(843) 553-5235
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2059735
UNITIED CONCORDIA
SC
05
—
ZX4473
—
SC
Enumeration date
04/05/2011
Last updated
04/05/2011
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