Organization
TIDELANDS DENTAL ON GLENNS BAY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER JONES (BUSINESS MANAGER)
(603) 531-1001
Entity
Organization
Contact information
Practice address
1625 GLENNS BAY RD, SURFSIDE BEACH, SC 29575-4836
(843) 650-4500
(843) 650-4510
Mailing address
3577 MARION LN, MURRELLS INLET, SC 29576-6012
(603) 531-1001
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/24/2020
Last updated
01/24/2020
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