| Lake Wylie Modern Dentistry | |
|
140 Highway 274 Lake Wylie SC 29710-6045 | |
| (803) 752-0565 | |
| Not Available |
| Full Name | Lake Wylie Modern Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 140 Highway 274, Lake Wylie, South Carolina |
| Authorized Official Name and Position | Ali Shahrestani (OWNER) |
| Authorized Official Contact | 8037520565 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Wylie Modern Dentistry Po Box 920050 Dallas TX 75392-0050 Ph: () - | Lake Wylie Modern Dentistry 140 Highway 274 Lake Wylie SC 29710-6045 Ph: (803) 752-0565 |
| NPI Number | 1194376491 |
|---|---|
| Provider Enumeration Date | 09/27/2019 |
| Last Update Date | 06/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194376491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
Dr Thomas N Stall Dmd Or Dr Stacy L Blackmon Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1100 Village Harbor Dr, Lake Wylie, SC 29710 Phone: 803-831-8856 Fax: 803-831-8966 | |
Carolina Family Dentistry At Lake Wylie Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 244 Latitude Ln Ste 103, Lake Wylie, SC 29710 Phone: 803-831-2171 Fax: 803-831-2172 |