Provider Demographics
NPI:1821975590
Name:FIFE DENTAL LLC
Entity type:Organization
Organization Name:FIFE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-512-3979
Mailing Address - Street 1:776 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7348
Mailing Address - Country:US
Mailing Address - Phone:843-326-4227
Mailing Address - Fax:
Practice Address - Street 1:776 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7348
Practice Address - Country:US
Practice Address - Phone:843-326-4227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty