| Coastal Carolina Oral Maxillofacial Surgery | |
|
133 Towne Centre Pkwy Myrtle Beach SC 29579 | |
| (843) 448-1621 | |
| (843) 626-2501 |
| Full Name | Coastal Carolina Oral Maxillofacial Surgery |
|---|---|
| Speciality | Dentist |
| Location | 133 Towne Centre Pkwy, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Wilma Pond (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 8434481621 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Carolina Oral Maxillofacial Surgery 133 Towne Centre Pkwy Myrtle Beach SC 29579 Ph: (843) 448-1621 | Coastal Carolina Oral Maxillofacial Surgery 133 Towne Centre Pkwy Myrtle Beach SC 29579 Ph: (843) 448-1621 |
| NPI Number | 1194812339 |
|---|---|
| Provider Enumeration Date | 10/09/2006 |
| Last Update Date | 04/11/2024 |
| Medicare PECOS PAC ID | 8628011798 |
|---|---|
| Medicare Enrollment ID | O20050609000319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194812339 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| Provider Name | Edward F Eckert |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1245329051 PECOS PAC ID: 4385687458 Enrollment ID: I20050609000292 |
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