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Organization
HERITAGE DENTAL LLC
Active
Organization
HERITAGE DENTAL LLC
Active
Other names
Heritage Dental LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT ALAN BREAULT DMD (PRESIDENT)
(860) 573-5681
Entity
Organization
Contact information
Practice address
9598 PALMETTO COMMERCE PARKWAY, LADSON, SC 29456
(860) 573-5681
Mailing address
9598 PALMETTO COMMERCE PARKWAY, LADSON, SC 29456
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
8323
SC
Other
Enumeration date
06/19/2017
Last updated
06/20/2018
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