Provider Demographics
NPI:1962076398
Name:SENSATIONAL SMILES OF CHARLESTON, LLC
Entity type:Organization
Organization Name:SENSATIONAL SMILES OF CHARLESTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUTECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-569-8795
Mailing Address - Street 1:597 OLD MOUNT HOLLY RD STE 209
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2832
Mailing Address - Country:US
Mailing Address - Phone:843-569-8795
Mailing Address - Fax:843-569-8797
Practice Address - Street 1:597 OLD MOUNT HOLLY RD STE 209
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2832
Practice Address - Country:US
Practice Address - Phone:843-569-8795
Practice Address - Fax:843-569-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC123OtherWHOEVER