| Division Of Oral Pathology | |
|
173 Ashley Ave Charleston SC 29425-8908 | |
| (843) 792-4495 | |
| (843) 792-3697 |
| Full Name | Division Of Oral Pathology |
|---|---|
| Speciality | Dentist |
| Location | 173 Ashley Ave, Charleston, South Carolina |
| Authorized Official Name and Position | Brad W. Neville (DIRECTOR OF DIVISION OF ORAL PATHOL) |
| Authorized Official Contact | 8437924496 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Division Of Oral Pathology Msc 507 173 Ashley Avenue Charleston SC 29425-0001 Ph: (843) 792-4495 | Division Of Oral Pathology 173 Ashley Ave Charleston SC 29425-8908 Ph: (843) 792-4495 |
| NPI Number | 1194026153 |
|---|---|
| Provider Enumeration Date | 11/08/2010 |
| Last Update Date | 03/04/2020 |
| Medicare PECOS PAC ID | 2365403698 |
|---|---|
| Medicare Enrollment ID | O20120316000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194026153 | NPI | - | NPPES |
| ZX0019 | Medicaid | SC | |
| 2375 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | (* (Not Available)) | Primary |
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