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General NPI Number Information
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NPI Number | 1043626005
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Entity Type | Organization
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Legal Business Name | CAROLINA FAMILY DENTAL
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 3702 SEA MOUNTAIN HWY
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City | LITTLE RIVER
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State | SC
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Zip | 29566-7860
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Country | US
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Telephone | 843-734-0212
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Fax | 843-734-0215
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Provider Business Mailing Address
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Address Line | 3702 SEA MOUNTAIN HWY
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City | LITTLE RIVER
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State | SC
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Zip | 29566-7860
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Country | US
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Telephone | 843-734-0212
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Fax | 843-734-0215
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Authorized Official
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Title or Position | OFFICE
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Name | MRS. TONYA RENE SUGGS
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Credential |
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Telephone | 843-734-0212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3622
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License Number State | SC
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