Healthcare Provider Details

I. General information

NPI: 1174454243
Provider Name (Legal Business Name): GEOFFREY RACINE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HIGHWAY 17 S
NORTH MYRTLE BEACH SC
29582-3117
US

IV. Provider business mailing address

101 HIGHWAY 17 S
NORTH MYRTLE BEACH SC
29582-3117
US

V. Phone/Fax

Practice location:
  • Phone: 843-888-2082
  • Fax:
Mailing address:
  • Phone: 843-973-7540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDGD.11447.GD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: