Organization
CRYSTAL ISENHOWER, DMD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRYSTAL RAE ISENHOWER DMD (DENTIST)
(843) 234-3110
Entity
Organization
Contact information
Practice address
107 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8902
(843) 234-3110
(843) 234-3109
Mailing address
107 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8902
(843) 234-3110
(843) 234-3109
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3529
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA967S
—
SC
Enumeration date
08/21/2006
Last updated
08/22/2020
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