| Modern Legacy, Inc. | |
|
203 S Marion St Latta SC 29565-1522 | |
| (843) 752-7655 | |
| (843) 752-4500 |
| Full Name | Modern Legacy, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 203 S Marion St, Latta, South Carolina |
| Authorized Official Name and Position | Jachelle Ag Sprattling (SECRETARY) |
| Authorized Official Contact | 8438104259 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Legacy, Inc. 203 S Marion St Latta SC 29565-1522 Ph: (843) 752-7655 | Modern Legacy, Inc. 203 S Marion St Latta SC 29565-1522 Ph: (843) 752-7655 |
| NPI Number | 1992032486 |
|---|---|
| Provider Enumeration Date | 11/04/2009 |
| Last Update Date | 08/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992032486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Latta Smiles Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 203 S Marion St, Latta, SC 29565 Phone: 843-752-7655 Fax: 843-752-4500 |