Charleston Oral and Facial Surgery, Inc.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4006 Issued in SC

Legal business name

CHARLESTON ORAL AND FACIAL SURGERY, INC.

Practice address

3700 Ingleside Blvd
Ladson, SC 29456-4141

Phone

(843) 762-9028

NPI assigned

Oct 16, 2007

Organization subpart

Yes

Parent organization

CHARLESTON ORAL AND FACIAL SURGERYAs reported in NPPES

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

Authorized official

Name

Jackie Holloway

Title

Director of RCM

Phone

(854) 200-7970

Specialties & licenses 1

Addresses

Other names 1

• Charleston Center for Oral & Facial Surgery Former legal business name

Part of

Charleston Center for Oral Facial Surgery

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Kinon Lecholop, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Charleston, SC
  • NPI 1902069271
  NPD (past)
• Daniel Graham Lee, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Charleston, SC
  • NPI 1912346586
  NPD (past)
• Nabil Moussa, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Ladson, SC
  • NPI 1073965174
  NPD (past)
• Aaron Partha Sarathy, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Beaufort, SC
  • NPI 1184695355
  NPD (past)

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785196800000",
    "number": "1043409063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 INGLESIDE BLVD STE 1",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564141",
            "telephone_number": "843-762-9028",
            "fax_number": "843-762-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 INGLESIDE BLVD",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564141",
            "telephone_number": "843-762-9028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1210 Wilson Hall Rd",
            "address_purpose": "LOCATION",
            "city": "Sumter",
            "state": "SC",
            "postal_code": "291501889",
            "country_code": "US",
            "telephone_number": "843-762-9028",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "75 Baylor Dr Ste 280",
            "address_purpose": "LOCATION",
            "city": "Bluffton",
            "state": "SC",
            "postal_code": "299108977",
            "country_code": "US",
            "telephone_number": "843-762-9028",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Hospital Ctr Ste 1",
            "address_purpose": "LOCATION",
            "city": "Hilton Head Island",
            "state": "SC",
            "postal_code": "299262734",
            "country_code": "US",
            "telephone_number": "843-762-9028",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1178 Bees Ferry Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Johns Island",
            "state": "SC",
            "postal_code": "294558381",
            "country_code": "US",
            "telephone_number": "843-762-9028",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5010 Paulsen St",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314054513",
            "country_code": "US",
            "telephone_number": "843-762-9028",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "125 Wappoo Creek Dr Ste 1",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294122163",
            "country_code": "US",
            "telephone_number": "843-762-9028",
            "fax_number": "843-762-9030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3070 N Highway 17 Ste 102",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "SC",
            "postal_code": "294669300",
            "country_code": "US",
            "telephone_number": "843-762-9028",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2080 Royle Rd",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294861301",
            "country_code": "US",
            "telephone_number": "843-762-9028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHARLESTON ORAL AND FACIAL SURGERY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLESTON ORAL AND  FACIAL SURGERY",
        "enumeration_date": "2007-10-16",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A",
        "authorized_official_last_name": "HOLLOWAY",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "DIRECTOR OF RCM",
        "authorized_official_telephone_number": "854-200-7970"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "4006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charleston Center for Oral & Facial Surgery",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Cataract and Laser Center of Charleston
• Center for Advanced Surgery LLC
• Charleston Brace Company, LLC
• Charleston Neuroscience Institute LLC
• Charleston Neuroscience Institute LLC
• Charleston Oral Medicine, LLC
• Heather Chesler, CCC-SLP
• Childrens Eye Specialists LLC
• Caroline Chism, CCC-SLP
• Tanya Chmunevich, CCC-SLP

• Oral and Maxillofacial Surgery (Dentist) in Ladson, SC
• Providers in Ladson, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; 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.