Healthcare Provider Details

I. General information

NPI: 1720223506
Provider Name (Legal Business Name): STEPHEN M. AIKEN, D.M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4932 HWY 17 BYP S
MYRTLE BEACH SC
29588-1619
US

IV. Provider business mailing address

4932 HWY 17 BYP S
MYRTLE BEACH SC
29588-1619
US

V. Phone/Fax

Practice location:
  • Phone: 843-293-5546
  • Fax:
Mailing address:
  • Phone: 843-293-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2614
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. STEPHEN M. AIKEN
Title or Position: MANAGER
Credential:
Phone: 843-293-5546