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Organization
GRAND STRAND PEDIATRIC DENTISTRY
Active
Organization
GRAND STRAND PEDIATRIC DENTISTRY
Active
Parent organization
GRAND STRAND PEDIATRIC DENTISTRY
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRAND STRAND PEDIATRIC DENTISTRY
Authorized official
DR. WINONA M NEWMAN DMD (OWNER)
(843) 294-5437
Entity
Organization
Contact information
Practice address
3112 DICK POND ROAD, MYRTLE BEACH, SC 29588-4833
(843) 294-5437
(843) 294-5440
Mailing address
3112 DICK POND ROAD, MYRTLE BEACH, SC 29588-4833
(843) 294-5437
(843) 294-5440
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
3125
SC
1223P0221X
Pediatric Dentistry
Primary
3125SC
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9590
—
SC
Enumeration date
05/14/2007
Last updated
03/03/2010
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