Organization
JEFFREY H WALLEN D.D.S. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY HUGH WALLEN D.D.S. (OWNER)
(843) 449-4993
Entity
Organization
Contact information
Practice address
1200 48TH AVE N STE 101, MYRTLE BEACH, SC 29577-5423
(843) 449-4993
(843) 497-0647
Mailing address
1200 48TH AVE N STE 101, MYRTLE BEACH, SC 29577-5423
(843) 449-4993
(843) 497-0647
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2959
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8998844
NORTH CAROLINA MEDICIAD
NC
05
—
ZA9905
—
SC
Enumeration date
04/09/2007
Last updated
06/05/2008
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