CHARLESTON PERIODONTICSPA NPI 1003955659

NPI Information

  • NPI: 1003955659
  • Provider Name: CHARLESTON PERIODONTICSPA
  • Classification: Dentist - 1223P0300X
  • Specialization: Periodontics
  • Entity Type: Organization
  • Address: 1051 GARDNER RD
    SUITE A
    CHARLESTON, SC
    ZIP 29407
  • Phone: (843) 766-7131

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NPI Details

CHARLESTON PERIODONTICSPA is a periodontics dentist in Charleston, SC. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. CHARLESTON PERIODONTICSPA NPI is 1003955659. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1051 GARDNER RD
SUITE A
CHARLESTON, SC
ZIP 29407-747
Phone: (843) 766-7131
Fax: (843) 766-1839

The provider's authorized official is Jeffrey J Laro .
The authorized official title is Periodontist and has the following contact phone number (843) 766-7131.

The enumeration date for this NPI number is 2/6/2007 and was last updated on 5/2/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0300XDentistPeriodonticsYes

What is NPI?

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This page was last updated on: 3/30/2025

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