| Grand Strand Pediatric Dentistry | |
|
3112 Dick Pond Road Myrtle Beach SC 29588-4833 | |
| (843) 294-5437 | |
| (843) 294-5440 |
| Full Name | Grand Strand Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3112 Dick Pond Road, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Winona M Newman (OWNER) |
| Authorized Official Contact | 8432945437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Strand Pediatric Dentistry 3112 Dick Pond Road Myrtle Beach SC 29588-4833 Ph: (843) 294-5437 | Grand Strand Pediatric Dentistry 3112 Dick Pond Road Myrtle Beach SC 29588-4833 Ph: (843) 294-5437 |
| NPI Number | 1881800480 |
|---|---|
| Provider Enumeration Date | 05/14/2007 |
| Last Update Date | 03/03/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881800480 | NPI | - | NPPES |
| ZA9590 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 3125 (South Carolina) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 3125SC (South Carolina) | Primary |
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