Charleston Pediatric Dentistry, P.a.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2638-0358 SC Issued in SC

Legal business name

CHARLESTON PEDIATRIC DENTISTRY, P.A.

Practice address

9217 University Blvd Ste 1C
North Charleston, SC 29406-9147

Phone

(843) 797-5133

Fax

(843) 797-5865

NPI assigned

Mar 28, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Bodiford

Title

Office Manager

Phone

(843) 797-5133

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033238589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9217 UNIVERSITY BLVD STE 1C",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069147",
            "telephone_number": "843-797-5133",
            "fax_number": "843-797-5865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9217 UNIVERSITY BLVD STE 1C",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069147",
            "telephone_number": "843-797-5133",
            "fax_number": "843-797-5865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON PEDIATRIC DENTISTRY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BODIFORD",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "843-797-5133"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "2638-0358 SC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charleston Nephrology Associates, LLC
• Charleston Orphan House (Carolina Youth Development Center)
• Charleston Orphan House, Inc (Carolina Youth Development Center)
• Charleston Orphan House, Inc. (Carolina Youth Development Center)
• Charleston Pain Relief Center
• Charleston Pediatric Rehabilitation
• Charleston Physicians for Women PLLC
• Charleston Specialty Rehab Institute Limited Partnership
• Charleston Surgical Consultants, LLC (The Charleston Sinus Center/Russell Facial Plastic Surgery)
• Charleston VA Cmop

• Pediatric Dentistry in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.