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NPI Code Detail

MEDICARE: DR. SANDRA M. HALTERMAN OS, DDS

MEDICARE: DR. SANDRA M. HALTERMAN OS, DDS
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
11223G0001XGeneral Practice Dentistry9473SC
21223S0112XOral and Maxillofacial Surgery (Dentist)2026SC

General Provider Information

NPI Number : 1083863633
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA M. HALTERMAN OS, DDS
Provider Business Mailing Address
First Line : PO BOX 547
Second Line :
City : LITTLE RIVER
State : SC
Zip : 29566-0547
Country : US
Telephone Number : 843-663-8000
Fax Number : 843-663-8166
Provider Business Practice Location Address
First Line : 4220 CAROLINA EXCHANGE DR
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-4220
Country : US
Telephone Number : 843-663-8000
Fax Number : 843-663-8166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2008
Last Update Date : 12/12/2024

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