Provider Demographics
NPI:1144683632
Name:APEX ORAL SURGERY, INC
Entity type:Organization
Organization Name:APEX ORAL SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:MARVIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-827-7677
Mailing Address - Street 1:664 LONG POINT RD UNIT B
Mailing Address - Street 2:UNIT B
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8316
Mailing Address - Country:US
Mailing Address - Phone:843-790-4667
Mailing Address - Fax:866-362-1232
Practice Address - Street 1:664 LONG POINT RD UNIT B
Practice Address - Street 2:UNIT B
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8316
Practice Address - Country:US
Practice Address - Phone:843-790-4667
Practice Address - Fax:866-362-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8331; 878OS261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205064318OtherINDIVIDUAL NPI
SCZX8331Medicaid