| Myrtle Beach Smiles Youth Dentistry, Llc | |
|
1317 N Kings Hwy Suite 106 Myrtle Beach SC 29577-3636 | |
| (843) 626-5437 | |
| (843) 626-6308 |
| Full Name | Myrtle Beach Smiles Youth Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1317 N Kings Hwy, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Jenell Stump (MANAGER, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 6157500343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Myrtle Beach Smiles Youth Dentistry, Llc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | Myrtle Beach Smiles Youth Dentistry, Llc 1317 N Kings Hwy Suite 106 Myrtle Beach SC 29577-3636 Ph: (843) 626-5437 |
| NPI Number | 1568432391 |
|---|---|
| Provider Enumeration Date | 01/24/2006 |
| Last Update Date | 07/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568432391 | NPI | - | NPPES |
| ZA9485 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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