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General NPI Number Information
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NPI Number | 1548688609
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Entity Type | Organization
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Legal Business Name | SEA SMILES PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 168 BLUFFTON RD
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City | BLUFFTON
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State | SC
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Zip | 29910-6248
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Country | US
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Telephone | 989-415-3397
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Fax |
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Provider Business Mailing Address
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Address Line | 168 BLUFFTON RD
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City | BLUFFTON
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State | SC
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Zip | 29910-6248
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | SHANE HARPHAM
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Credential | D.D.S.
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Telephone | 989-415-3397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8196
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License Number State | SC
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