Provider Demographics
NPI:1235312356
Name:CHADWICK & KOLMODIN
Entity type:Organization
Organization Name:CHADWICK & KOLMODIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-744-6971
Mailing Address - Street 1:1818 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410
Mailing Address - Country:US
Mailing Address - Phone:843-744-6971
Mailing Address - Fax:843-744-3120
Practice Address - Street 1:1818 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410
Practice Address - Country:US
Practice Address - Phone:843-744-6971
Practice Address - Fax:843-744-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3252122300000X
SC3436122300000X
SC1206122300000X
SC963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ09633Medicaid
SCZ32527Medicaid
SCZ34368Medicaid
SCZ12068Medicaid