Healthcare Provider Details

I. General information

NPI: 1679282933
Provider Name (Legal Business Name): MYRTLE BEACH ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HILTON RD STE 201
MYRTLE BEACH SC
29572-6623
US

IV. Provider business mailing address

350 HILTON RD STE 201
MYRTLE BEACH SC
29572-6623
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-3707
  • Fax: 843-497-3717
Mailing address:
  • Phone: 630-992-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM JUSTIN CROSBY
Title or Position: OWNER
Credential: DDS
Phone: 843-497-3707