# LITTLE WAVES PEDIATRIC DENTISTRY

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

## Provider details

- **NPI number:** 1336917145
- **Authorized official:** LORI PORRAS DMD (PEDIATRIC DENTIST)
- **Authorized official phone:** (954) 383-3893

## Contact information

- **Practice address:** 4603 OLEANDER DRIVE, UNIT 3,4,5, MYRTLE BEACH, SC 29577
- **Practice address phone:** (843) 353-3319
- **Practice address fax:** (843) 353-3238
- **Mailing address:** 584 STARLIT WAY, MYRTLE BEACH, SC 29579-4322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/12/2023
- **Last updated:** 05/30/2024