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General NPI Number Information
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NPI Number | 1871942391
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SMILES, LLC
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 19 PROMENADE ST UNIT 201
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City | BLUFFTON
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State | SC
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Zip | 29910-7037
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Country | US
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Telephone | 843-707-7915
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Fax |
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Provider Business Mailing Address
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Address Line | 19 PROMENADE ST UNIT 201
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City | BLUFFTON
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State | SC
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Zip | 29910-7037
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Country | US
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Telephone | 843-707-7915
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Fax |
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. COURTNEY DAVIS
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Credential | D.D.S
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Telephone | 843-707-7915
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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 | 8543-869
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License Number State | SC
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