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General NPI Number Information
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NPI Number | 1386734804
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL SOLUTIONS, LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 32 OFFICE PARK RD SUITE 207
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City | HILTON HEAD
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State | SC
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Zip | 29928-4637
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Country | US
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Telephone | 843-785-4801
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Fax | 843-785-7804
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Provider Business Mailing Address
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Address Line | 32 OFFICE PARK RD SUITE 207
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City | HILTON HEAD
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State | SC
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Zip | 29928-4637
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Country | US
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Telephone | 843-785-4801
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Fax | 843-785-7804
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH LLOYD GUDZ
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Credential | D.M.D.
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Telephone | 843-785-4801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | SC3319
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License Number State | SC
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