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General NPI Number Information
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NPI Number | 1457653313
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Entity Type | Organization
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Legal Business Name | ADULT & CHILDREN DENTISTRY AT INLET MEDICAL, LLC
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 912 INLET SQUARE DR
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City | MURRELLS INLET
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State | SC
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Zip | 29576-7812
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Country | US
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Telephone | 843-651-9009
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Fax | 843-651-1047
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Provider Business Mailing Address
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Address Line | 912 INLET SQUARE DR
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City | MURRELLS INLET
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State | SC
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Zip | 29576-7812
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Country | US
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Telephone | 843-651-9009
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Fax | 843-651-1047
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. WILLIAM JACKSON EPPERSON
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Credential | M.D.
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Telephone | 843-651-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD12346
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License Number State | SC
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