Healthcare Provider Details

I. General information

NPI: 1033448758
Provider Name (Legal Business Name): HILTON HEAD ISLAND ORAL AND MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BILL FRIES DR
HILTON HEAD ISLAND SC
29926-2730
US

IV. Provider business mailing address

35 BILL FRIES DR
HILTON HEAD ISLAND SC
29926-2730
US

V. Phone/Fax

Practice location:
  • Phone: 843-689-6338
  • Fax:
Mailing address:
  • Phone: 843-689-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3907
License Number StateSC

VIII. Authorized Official

Name: DR. BRIAN LOW
Title or Position: ORAL AND MAXILLOFACIAL SURGEON
Credential: D. M. D.
Phone: 843-689-6338