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1470 Tobias Gadson Blvd Suite 100 Charleston SC 29407-4707 | |
| (843) 571-5644 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1470 Tobias Gadson Blvd, Charleston, South Carolina |
| Authorized Official Name and Position | Charles Coulter (OWNER) |
| Authorized Official Contact | 7706921000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1350 Spring Street Suite 600 Atlanta GA 30309-2870 Ph: (770) 692-1000 | 1470 Tobias Gadson Blvd Suite 100 Charleston SC 29407-4707 Ph: (843) 571-5644 |
| NPI Number | 1790020907 |
|---|---|
| Provider Enumeration Date | 11/29/2012 |
| Last Update Date | 10/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790020907 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 3253 (South Carolina) | Primary |
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