Provider Demographics
NPI:1851918882
Name:E.L. CENTRE POINTE PROFESSIONAL LLC
Entity type:Organization
Organization Name:E.L. CENTRE POINTE PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:LISZKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-277-0102
Mailing Address - Street 1:4965 CENTRE POINTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-6945
Mailing Address - Country:US
Mailing Address - Phone:843-277-0102
Mailing Address - Fax:843-277-0422
Practice Address - Street 1:4965 CENTRE POINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6945
Practice Address - Country:US
Practice Address - Phone:843-277-0102
Practice Address - Fax:843-277-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty