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General NPI Number Information
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NPI Number | 1053376491
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Entity Type | Organization
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Legal Business Name | KIDS TEETH, LLC
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 1130 PROFESSIONAL LN
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City | MOUNT PLEASANT
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State | SC
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Zip | 29466-7193
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Country | US
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Telephone | 843-216-5879
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Fax | 843-310-3771
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Provider Business Mailing Address
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Address Line | 1130 PROFESSIONAL LN
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City | MT PLEASANT
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State | SC
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Zip | 29466-7193
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Country | US
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Telephone | 843-216-5879
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Fax | 843-216-5891
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Authorized Official
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Title or Position | FINANCIAL COORDINATOR
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Name | REBECCA TORLAY - KURSH
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Credential |
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Telephone | 843-216-5879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3030
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 7171
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3881
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3863
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2085
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License Number State | SC
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