Healthcare Provider Details

I. General information

NPI: 1063193936
Provider Name (Legal Business Name): BEAUFORT SMILES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27A KEMMERLIN LN
BEAUFORT SC
29907-2702
US

IV. Provider business mailing address

27A KEMMERLIN LN
BEAUFORT SC
29907-2702
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRITANY SACKMAN
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 843-522-2077