Healthcare Provider Details

I. General information

NPI: 1548118193
Provider Name (Legal Business Name): DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11832 HIGHWAY 707
MURRELLS INLET SC
29576-9712
US

IV. Provider business mailing address

11832 HIGHWAY 707
MURRELLS INLET SC
29576-9712
US

V. Phone/Fax

Practice location:
  • Phone: 843-286-4620
  • Fax:
Mailing address:
  • Phone: 843-286-4620
  • 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: CEMYIRA MCDOUGAL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-764-8609