Organization
HERITAGE DENTAL LLC
Active
Other names
Heritage Dental LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT ALAN BREAULT DMD (PRESIDENT)
(860) 573-5681
Entity
Organization
Contact information
Practice address
9598 PALMETTO COMMERCE PARKWAY, LADSON, SC 29456
(860) 573-5681
Mailing address
9598 PALMETTO COMMERCE PARKWAY, LADSON, SC 29456
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
8323
SC
Other
Enumeration date
06/19/2017
Last updated
06/20/2018
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