CHARLESTON PERIODONTICSPA (NPI# 1003955659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003955659 |
| Entity Type | Organization |
| Organization Name | CHARLESTON PERIODONTICSPA |
| Practice Address |
1051 Gardner Rd Suite A Charleston SC 29407-5747 |
| Practice Telephone | 8437667131 |
| Practice Fax Number | 8437661839 |
| Mailing Telephone | 8437667131 |
| Mailing Fax Number | 8437661839 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2011-05-02 |
| Authorized Official Name | DR. JEFFREY J LARO (PERIODONTIST) |
| Authorized Official Telephone | 8437667131 |
| Authorized Official Credential | DMD MHS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
1051 GARDNER RD SUITE A |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29407-5747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255317152 | Roy Edward Hudgens IIi | Dentist | 1051 Gardner Rd, Suite C, Charleston, SC 29407-5747 | 2005-12-21 |
| 1558695809 | Margaret E Alderman | Dentist | 1051 Gardner Rd, Ste D, Charleston, SC 29407-5747 | 2009-09-18 |
| 1598932881 | Stone Family Dentistry | Dentist | 1051 Gardner Rd, Suite D, Charleston, SC 29407-5747 | 2008-05-15 |
| 1609902329 | David Washington Stone Jr. | Dentist | 1051 Gardner Rd, Suite D, Charleston, SC 29407-5747 | 2007-02-26 |
| 1447385752 | Deborah Denise Stone | Dentist | 1051 Gardner Rd, Suite D, Charleston, SC 29407-5747 | 2007-02-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437763661 | Charleston Jaw Surgery | Oral & Maxillofacial Surgery | 846 St. Andrews Blvd., Charleston, SC 29407 | 2020-09-04 |
| 1780225128 | New Endeavors Counseling | Social Worker | 1 Carriage Lane Building E Suite 202, Charleston, SC 29407 | 2019-10-07 |
| 1770063158 | Katelyn Campbell | Psychologist | 1 Carriage Ln Ste 102, Charleston, SC 29407 | 2018-08-15 |
| 1164929956 | Anisha Gulati Md LLC | Psychiatry & Neurology | 925 Wappoo Rd., Suite F, Charleston, SC 29407 | 2018-04-09 |
| 1316459753 | David W Richardson | Dentist | 765 St. Andrews Blvd., Charleston, SC 29407 | 2017-10-25 |
| 1457874174 | Meca Mentality LLC | Chiropractor | 1106 St Andrews Blvd Suite A, Charleston, SC 29407 | 2017-07-25 |
| 1639609373 | Carolina Behavioral Specialists, LLC | Behavioral Analyst | 1529 Sam Rittenberg Blvd, Unit 1-b, Charleston, SC 29407 | 2017-06-15 |
| 1467991901 | Bernice Ladson | Registered Nurse | 75o Magnolia Road, Charleston, SC 29407 | 2017-02-16 |
| 1376991257 | Virginia Leigh Thomason | Counselor | 29 Leinbach Dr, Suite D2, Charleston, SC 29407 | 2016-06-01 |
| 1609221001 | Elinor Lee Smith | Counselor | 571 Savannah Hwy, Charleston, SC 29407 | 2016-05-04 |
| Find all providers in zip 29407 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487184727 | Hillary Nona Wright | Dentist | 1064 Gardner Rd Ste 110, Charleston, SC 29407-5711 | 2017-06-19 |
| 1134472426 | Jeffrey J Laro | Dentist | 2090 Charlie Hall Blvd, Suite 100, Charleston, SC 29414-8200 | 2012-10-24 |
| 1407117385 | Kara Grasso Veeder | Dentist | 173 Ashley Ave Ste 119, Charleston, SC 29425-8908 | 2012-06-06 |
| 1013288786 | Periodontal Associates LLC | Dentist | 33 Gamecock Ave Ste A, Charleston, SC 29407-3397 | 2012-01-26 |
| 1508089301 | Christine Marie Cole | Dentist | 520 Stone Creek Dr, Charleston, SC 29414-5051 | 2007-04-10 |
| 1457476566 | Christopher Jude Caputo | Dentist | 33a Gamecock Ave, Periodontal Associates, Pa, Charleston, SC 29407-3369 | 2007-03-20 |
| 1669530994 | Joe William Krayer | Dentist | 173 Ashley Bsb 346, Dental Faculty Prac College of Dental Medicine Musc, Charleston, SC 29425 | 2006-12-06 |
| 1629585880 | Renata Serricchio Leite | Dentist | 29 Bee Street, Charleston, SC 29425-0001 | 2018-01-09 |
| 1740646769 | Trident Dental Specialty Partners | Dentist | 6335 Dorchester Rd, Charleston, SC 29418-5103 | 2016-01-06 |
| 1114332921 | Zachary P Evans | Dentist | 1064 Gardner Rd, Suite #110, Charleston, SC 29407-5768 | 2014-07-01 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 29407 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.