Organization
TIDAL CREEK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE A GAILLARDETZ DMD (OWNER)
(603) 321-9029
Entity
Organization
Contact information
Practice address
1127 QUEENSBOROUGH BLVD, SUITE 107, MOUNT PLEASANT, SC 29464-5431
(603) 321-9029
Mailing address
1127 QUEENSBOROUGH BLVD, SUITE 107, MOUNT PLEASANT, SC 29464-5431
(603) 321-9029
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8715
SC
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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