Charles Johnson, DMD
Dentist, General Practice in Summerville, SC. Individual provider (NPI-1).
NPI number1164092441
StatusActive
Last updated in NPPESJun 29, 2021
Details
- NPI
- 1164092441
- Entity type
- Individual (NPI-1)
- Name
- Charles Johnson
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 29, 2021
- Certification date
- Jun 17, 2021
- Last updated
- Jun 29, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 9899 | SC | Yes |
Practice location
1720 Old Trolley RdSummerville, SC 29485-8278
Phone 864-640-6757
Mailing address
1629 Timothy StCharleston, SC 29407-7902
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