Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 8942 | SC |
NPI | 1104448760 |
---|---|
Provider Name | Christopher Michael Conzett |
First Address | Charleston, SC 29412-5200 |
Second Address | Spartanburg, SC 29301-1590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2020 |
Last Update Date | 17/05/2020 |