Healthcare Provider Details

I. General information

NPI: 1104766740
Provider Name (Legal Business Name): PERFECT VIEW DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 HIGHWAY 544
CONWAY SC
29526-8450
US

IV. Provider business mailing address

7404 GLACIER DR
EL PASO TX
79911-3154
US

V. Phone/Fax

Practice location:
  • Phone: 704-930-8910
  • Fax:
Mailing address:
  • Phone: 704-930-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY SCOTT JOHNSON
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 704-930-8910