Organization
LAKE WYLIE MODERN DENTISTRY, PC
Active
Other names
Lake Wylie Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALI SHAHRESTANI DMD (OWNER)
(803) 752-0565
Entity
Organization
Contact information
Practice address
140 HIGHWAY 274, LAKE WYLIE, SC 29710-6045
(803) 752-0565
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
09/27/2019
Last updated
06/14/2022
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