Healthcare Provider Details

I. General information

NPI: 1114688074
Provider Name (Legal Business Name): TWISS DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 CAROLINA FOREST BLVD
MYRTLE BEACH SC
29579
US

IV. Provider business mailing address

480 PLANTATION OAKS DR
MYRTLE BEACH SC
29579-3663
US

V. Phone/Fax

Practice location:
  • Phone: 503-688-3400
  • Fax:
Mailing address:
  • Phone: 503-688-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. JOSHUA TWISS
Title or Position: PRESIDENT
Credential: DDS
Phone: 503-688-3400