Healthcare Provider Details

I. General information

NPI: 1285069856
Provider Name (Legal Business Name): SMILES BY WYLES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 A KEMMERLIN LANE
BEAUFORT SC
29907
US

IV. Provider business mailing address

27 A KEMMERLIN LANE
BEAUFORT SC
29907
US

V. Phone/Fax

Practice location:
  • Phone: 843-522-2077
  • Fax: 843-522-9931
Mailing address:
  • Phone: 843-522-2077
  • Fax: 843-522-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberSC 2607
License Number StateSC

VIII. Authorized Official

Name: MRS. HEATHER LANGFORD
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 843-522-2077