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Organization
DENTAL WELLNESS CENTER OF MYRTLE BEACH, LLC
Active
Organization
DENTAL WELLNESS CENTER OF MYRTLE BEACH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMANDA RAY (FINANCIAL COORDINATOR)
(912) 920-5577
Entity
Organization
Contact information
Practice address
1017 HIGHWAY 501 STE 70, MYRTLE BEACH, SC 29577-3820
(843) 508-8782
(912) 226-3489
Mailing address
PO BOX 60339, SAVANNAH, GA 31420-0339
(912) 920-5577
(912) 226-3489
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497918759
NPI
GA
01
—
DN010747
STATE LICENSE
GA
Enumeration date
03/05/2019
Last updated
06/11/2019
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