MEDICARE: MARY ANN CHILDS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	3694	SC
2	332BC3200X	Customized Equipment (DME)	3694	SC
3	1223G0001X	General Practice Dentistry	3694	SC

General Provider Information

NPI Number	:	1700859733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN CHILDS D.M.D.

Provider Business Mailing Address
First Line	:	21 NEW ORLEANS RD STE A
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4797
Country	:	US
Telephone Number	:	864-233-4166
Fax Number	:	843-785-8206

Provider Business Practice Location Address
First Line	:	21 NEW ORLEANS RD STE A
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4797
Country	:	US
Telephone Number	:	843-785-6285
Fax Number	:	843-785-8206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	04/29/2025

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