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General NPI Number Information
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NPI Number | 1275402851
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Entity Type | Organization
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Legal Business Name | NEW YORK DENTAL SOUTH LLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 822 INLET SQUARE DR UNIT B
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City | MURRELLS INLET
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State | SC
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Zip | 29576-7810
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Country | US
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Telephone | 854-854-9001
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Fax | 854-854-9003
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Provider Business Mailing Address
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Address Line | 822 INLET SQUARE DR UNIT B
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City | MURRELLS INLET
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State | SC
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Zip | 29576-7810
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Country | US
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Telephone | 854-854-9001
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Fax | 854-854-9003
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. NIKOLAOS LAOUTARIS
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Credential | DDS
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Telephone | 854-854-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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