# GRAND STRAND PEDIATRIC DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GRAND STRAND PEDIATRIC DENTISTRY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1881800480
- **Legal business name:** GRAND STRAND PEDIATRIC DENTISTRY
- **Authorized official:** DR. WINONA M NEWMAN DMD (OWNER)
- **Authorized official phone:** (843) 294-5437

## Contact information

- **Practice address:** 3112 DICK POND ROAD, MYRTLE BEACH, SC 29588-4833
- **Practice address phone:** (843) 294-5437
- **Practice address fax:** (843) 294-5440
- **Mailing address:** 3112 DICK POND ROAD, MYRTLE BEACH, SC 29588-4833
- **Mailing address phone:** (843) 294-5437
- **Mailing address fax:** (843) 294-5440

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 3125 | SC | — |
| 1223P0221X | Pediatric Dentistry | 3125SC | SC | Yes |

## Other

- **Enumeration date:** 05/14/2007
- **Last updated:** 03/03/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZA9590 | — | SC |