Individual
JOHN MICHAEL REARDEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3012 NEWCASTLE LOOP, MYRTLE BEACH, SC 29588
(843) 215-2599
(843) 215-0238
Mailing address
3012 NEWCASTLE LOOP, MYRTLE BEACH, SC 29588
(843) 215-2599
(843) 215-0238
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3556
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02281972
—
SC
Enumeration date
05/04/2006
Last updated
07/08/2007
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