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General NPI Number Information
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NPI Number | 1780705616
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Entity Type | Individual
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Provider Name | MICHAEL GEORGE CARDOZO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 4999 CAROLINA FOREST BLVD, SUITE 14
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City | MRYTLE BEACH
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State | SC
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Zip | 29579-9998
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Country | US
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Telephone | 843-903-4700
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Fax | 843-903-4720
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Provider Business Mailing Address
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Address Line | 4999 CAROLINA FOREST BLVD STE 14
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-3588
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Country | US
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Telephone | 843-903-4700
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Fax | 843-903-4720
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4266
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License Number State | SC
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