MEDICARE: BEAUFORT SMILES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1063193936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUFORT SMILES PA

Provider Business Mailing Address
First Line	:	27A KEMMERLIN LN
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907-2702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	27A KEMMERLIN LN
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907-2702
Country	:	US
Telephone Number	:	843-522-2077
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	BRITANY SACKMAN
Credential	:
Telephone Number	:	843-522-2077

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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Directions to “BEAUFORT SMILES PA ” Practice Location

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