| Northside Family Dentistry | |
|
7481 Northside Drive Suite A North Charleston SC 29420-4282 | |
| (843) 863-8634 | |
| (843) 863-8242 |
| Full Name | Northside Family Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 7481 Northside Drive, North Charleston, South Carolina |
| Authorized Official Name and Position | Raymond S Vicente (DENTIST OWNER) |
| Authorized Official Contact | 8438638634 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northside Family Dentistry 7481 Northside Drive Suite A North Charleston SC 29420-4282 Ph: (843) 863-8634 | Northside Family Dentistry 7481 Northside Drive Suite A North Charleston SC 29420-4282 Ph: (843) 863-8634 |
| NPI Number | 1831371913 |
|---|---|
| Provider Enumeration Date | 11/30/2007 |
| Last Update Date | 11/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831371913 | NPI | - | NPPES |
| ZA9568 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | SC3976 (South Carolina) | Primary |
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