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General NPI Number Information
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NPI Number | 1477140226
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Entity Type | Organization
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Legal Business Name | SOUTH COAST DENTAL LLC
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 5879 HIGHWAY 707
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-7359
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Country | US
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Telephone | 843-650-4707
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Fax | 843-650-5151
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Provider Business Mailing Address
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Address Line | 889 BLUFFVIEW DR
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-5268
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Country | US
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Telephone | 843-446-3664
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Fax |
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Authorized Official
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Title or Position | MEMBER/DENTIST
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Name | DR. JUSTIN MICHAEL DAMMANN
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Credential | DMD
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Telephone | 843-446-3664
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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 |
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License Number State |
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