Organization
COASTAL CAROLINA ORAL MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILMA POND (PRACTICE ADMINISTRATOR)
(843) 448-1621
Entity
Organization
Contact information
Practice address
133 TOWNE CENTRE PKWY, MYRTLE BEACH, SC 29579
(843) 448-1621
(843) 626-2501
Mailing address
133 TOWNE CENTRE PKWY, MYRTLE BEACH, SC 29579
(843) 448-1621
(843) 626-2501
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Enumeration date
10/09/2006
Last updated
04/11/2024
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