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General NPI Number Information
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NPI Number | 1912746272
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Entity Type | Organization
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Legal Business Name | INNOVATIVE ENDODONTICS MB
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 3033 NEWCASTLE LOOP
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City | MYRTLE BEACH
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State | SC
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Zip | 29588
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Country | US
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Telephone | 843-900-3414
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Fax | 843-377-8695
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Provider Business Mailing Address
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Address Line | 227 STALLSVILLE LOOP SUITE A
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City | SUMMERVILLE
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State | SC
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Zip | 29485
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Country | US
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Telephone | 843-900-3414
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Fax | 843-377-8695
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Authorized Official
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Title or Position | OWNER, ENDODONTIST
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Name | MONICA R ESTES
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Credential | DMD, MSD
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Telephone | 603-986-3686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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