Healthcare Provider Details

I. General information

NPI: 1750768693
Provider Name (Legal Business Name): COURTNEY HOLMES SUGGS D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 INTERNATIONAL DR
MYRTLE BEACH SC
29579-3488
US

IV. Provider business mailing address

968 INTERNATIONAL DR
MYRTLE BEACH SC
29579-3488
US

V. Phone/Fax

Practice location:
  • Phone: 843-903-8800
  • Fax:
Mailing address:
  • Phone: 843-798-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8861
License Number StateSC

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: