Organization
INGLESIDE FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN BETTY MATHEW D.D.S (OWNER)
(845) 702-0581
Entity
Organization
Contact information
Practice address
9403 HIGHWAY 78, SUITE 201, LADSON, SC 29456
(845) 702-0581
Mailing address
9403 HIGHWAY 78, SUITE 201, LADSON, SC 29456
(845) 702-0581
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/20/2020
Last updated
03/20/2020
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