| Lake Moultrie Dental Llc | |
|
205 Carolina Ave Moncks Corner SC 29461-3736 | |
| (843) 761-8720 | |
| Not Available |
| Full Name | Lake Moultrie Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 205 Carolina Ave, Moncks Corner, South Carolina |
| Authorized Official Name and Position | Brian Lewis Jaques (OWNER/DENTIST) |
| Authorized Official Contact | 8437618720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Moultrie Dental Llc 205 Carolina Ave Moncks Corner SC 29461-3736 Ph: (843) 761-8720 | Lake Moultrie Dental Llc 205 Carolina Ave Moncks Corner SC 29461-3736 Ph: (843) 761-8720 |
| NPI Number | 1013482603 |
|---|---|
| Provider Enumeration Date | 10/10/2018 |
| Last Update Date | 10/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013482603 | NPI | - | NPPES |
| ZX8370 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Carolina Avenue Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 214 Carolina Avenue, Moncks Corner, SC 29461 Phone: 843-899-5911 Fax: 843-899-5961 | |
Carnes Crossroads Dental P.a Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3751 S Live Oak Dr, Suite G, Moncks Corner, SC 29461 Phone: 843-761-7380 Fax: 843-761-7385 | |
Dr. Craig Thomas, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 214 Carolina Ave, Moncks Corner, SC 29461 Phone: 843-899-5911 | |
Grosso Orthodontics Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 421 Barony St Ste 6, Moncks Corner, SC 29461 Phone: 843-899-5800 Fax: 843-899-5806 | |
Drs. Kunkle And Powell, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 119 Library St, Moncks Corner, SC 29461 Phone: 843-761-8065 Fax: 843-761-5085 | |
Carnes Crossroads Dental Arts P.a. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3751 S Live Oak Dr, Suite G, Moncks Corner, SC 29461 Phone: 843-761-7380 Fax: 843-761-7385 |