Provider Demographics
NPI:1649825969
Name:OAK LANDING PEDIATRIC DENTISTRY, LLC
Entity type:Organization
Organization Name:OAK LANDING PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-900-4490
Mailing Address - Street 1:3255 MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8052
Mailing Address - Country:US
Mailing Address - Phone:803-537-9136
Mailing Address - Fax:
Practice Address - Street 1:2001 2ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7887
Practice Address - Country:US
Practice Address - Phone:843-900-4490
Practice Address - Fax:843-501-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-04
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty