Provider Demographics
NPI:1104468172
Name:CHARLESTON DENTAL & DENTURES LLC
Entity type:Organization
Organization Name:CHARLESTON DENTAL & DENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-376-6328
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231-1332
Mailing Address - Country:US
Mailing Address - Phone:518-376-6328
Mailing Address - Fax:
Practice Address - Street 1:2020 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6286
Practice Address - Country:US
Practice Address - Phone:843-852-2400
Practice Address - Fax:843-852-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental