# JEFFREY H WALLEN D.D.S. P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134242621
- **Authorized official:** DR. JEFFREY HUGH WALLEN D.D.S. (OWNER)
- **Authorized official phone:** (843) 449-4993

## Contact information

- **Practice address:** 1200 48TH AVE N STE 101, MYRTLE BEACH, SC 29577-5423
- **Practice address phone:** (843) 449-4993
- **Practice address fax:** (843) 497-0647
- **Mailing address:** 1200 48TH AVE N STE 101, MYRTLE BEACH, SC 29577-5423
- **Mailing address phone:** (843) 449-4993
- **Mailing address fax:** (843) 497-0647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2959 | SC | Yes |

## Other

- **Enumeration date:** 04/09/2007
- **Last updated:** 06/05/2008