Organization
LONGBOARD DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN PAULISICK WOLF DDS, FAGD (DENTIST)
(843) 654-1373
Entity
Organization
Contact information
Practice address
405 FAISON ROAD, SUIRE A3, MT PLEASANT, SC 29466
(843) 654-1373
(843) 654-1374
Mailing address
405 FAISON ROAD, SUIRE A3, MT PLEASANT, SC 29466
(843) 654-1373
(843) 654-1374
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/14/2022
Last updated
11/14/2022
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