| Ladys Island Denal Clinic | |
|
5 Professional Village Cir Beaufort SC 29907-1571 | |
| (843) 521-0808 | |
| (843) 521-0945 |
| Full Name | Ladys Island Denal Clinic |
|---|---|
| Speciality | Dentist |
| Location | 5 Professional Village Cir, Beaufort, South Carolina |
| Authorized Official Name and Position | Tristan H Greenwalt (DENTIST) |
| Authorized Official Contact | 8435210808 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ladys Island Denal Clinic 5 Professional Village Cir Beaufort SC 29907-1571 Ph: (843) 521-0808 | Ladys Island Denal Clinic 5 Professional Village Cir Beaufort SC 29907-1571 Ph: (843) 521-0808 |
| NPI Number | 1386761955 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386761955 | NPI | - | NPPES |
| 923437 | Other | SC | UNITED CONCORDIA |
| ZX3760 | Medicaid | SC | |
| ZX3797 | Medicaid | SC | |
| ZA9682 | Medicaid | SC | |
| 970484 | Other | SC | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3760 (South Carolina) | Primary |
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