| Crystal Isenhower, Dmd, Llc | |
|
107 Waccamaw Medical Park Dr Conway SC 29526-8902 | |
| (843) 234-3110 | |
| (843) 234-3109 |
| Full Name | Crystal Isenhower, Dmd, Llc |
|---|---|
| Speciality | Dentist |
| Location | 107 Waccamaw Medical Park Dr, Conway, South Carolina |
| Authorized Official Name and Position | Crystal Rae Isenhower (DENTIST) |
| Authorized Official Contact | 8432343110 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Isenhower, Dmd, Llc 107 Waccamaw Medical Park Dr Conway SC 29526-8902 Ph: (843) 234-3110 | Crystal Isenhower, Dmd, Llc 107 Waccamaw Medical Park Dr Conway SC 29526-8902 Ph: (843) 234-3110 |
| NPI Number | 1629184171 |
|---|---|
| Provider Enumeration Date | 08/21/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629184171 | NPI | - | NPPES |
| ZA967S | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3529 (South Carolina) | Primary |
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