| Lockwood Dental Asscociates, Llc | |
|
14 Lockwood Drive Ste A Charleston SC 29401 | |
| (843) 722-8500 | |
| (843) 720-8555 |
| Full Name | Lockwood Dental Asscociates, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 14 Lockwood Drive, Charleston, South Carolina |
| Authorized Official Name and Position | Craig Steven Modzelewski (OWNER) |
| Authorized Official Contact | 8437228500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lockwood Dental Asscociates, Llc 14 Lockwood Drive Ste A Charleston SC 29401 Ph: (843) 722-8500 | Lockwood Dental Asscociates, Llc 14 Lockwood Drive Ste A Charleston SC 29401 Ph: (843) 722-8500 |
| NPI Number | 1548486566 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548486566 | NPI | - | NPPES |
| ZX3892 | Medicaid | SC | |
| Z13138 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3892 (South Carolina) | Secondary |
| 1223G0001X | Dentist - General Practice | 1313 (South Carolina) | Primary |
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