Healthcare Provider Details

I. General information

NPI: 1760585905
Provider Name (Legal Business Name): DUNES DENTAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 79TH AVE N
MYRTLE BEACH SC
29572-4304
US

IV. Provider business mailing address

304 79TH AVE N
MYRTLE BEACH SC
29572-4304
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-4812
  • Fax: 843-449-3632
Mailing address:
  • Phone: 843-449-4812
  • Fax: 843-449-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2977
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. H. EUGENE BUTLER III
Title or Position: DENTIST
Credential: D.M.D.
Phone: 843-449-4812