Healthcare Provider Details

I. General information

NPI: 1942524038
Provider Name (Legal Business Name): SMILE SOUTH CAROLINA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 BOWMAN RD PMB #4955919, SUITE 200
MT PLEASANT SC
29464-3803
US

IV. Provider business mailing address

33533 W 12 MILE RD SUITE 150
FARMINGTON HILLS MI
48331-3354
US

V. Phone/Fax

Practice location:
  • Phone: 888-833-8441
  • Fax: 888-330-4331
Mailing address:
  • Phone: 888-833-8441
  • Fax: 888-330-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4648
License Number StateSC

VIII. Authorized Official

Name: ELLIOT P. SCHLANG
Title or Position: DENTAL DIRECTOR
Credential: DDS
Phone: 888-833-8441