Organization
VILLAGE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MICHAEL REARDEN JR. DMD (OWNER/DENTIST)
(843) 215-2599
Entity
Organization
Contact information
Practice address
3012 NEWCASTLE LOOP, MYRTLE BEACH, SC 29588-4501
(843) 215-2599
Mailing address
3012 NEWCASTLE LOOP, MYRTLE BEACH, SC 29588-4501
(843) 215-2599
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
90157
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9719
—
SC
Enumeration date
12/03/2007
Last updated
12/03/2007
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