Individual
BENJAMIN THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
1247 HIGHWAY 17, LITTLE RIVER, SC 29566-9211
(843) 249-4092
Mailing address
1247 HIGHWAY 17, LITTLE RIVER, SC 29566-9211
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.11518.GD
SC
Other
Enumeration date
07/13/2026
Last updated
07/13/2026
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