Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 1839 | SC |
N | 1223E0200X | Endodontist | 1839 | SC |
Y | 1223G0001X | General Practice | 1839 | SC |
Y | 213EG0000X | General Practice | 1839 | SC |
N | 1223P0300X | Periodontist | 1839 | SC |
N | 1223P0700X | Prosthodontist | 1839 | SC |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 1839 | SC |
N | 1223X0400X | Orthodontists | 1839 | SC |
NPI | 1114085289 |
---|---|
Provider Name | Dr. James Charles Andrews |
First Address | Summerville, SC 29485-8278 |
Second Address | Summerville, SC 29485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 30/05/2018 |