Provider Demographics
NPI:1497448690
Name:RESTREPO, CARLOS MARIO (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MARIO
Last Name:RESTREPO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 CECILE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3888
Mailing Address - Country:US
Mailing Address - Phone:864-908-2047
Mailing Address - Fax:
Practice Address - Street 1:234 SEVEN FARMS DR
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8107
Practice Address - Country:US
Practice Address - Phone:843-284-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10508122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist