MEDICARE: DR. GEOFFREY RACINE DMD

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	DGD.11447.GD	SC

General Provider Information

NPI Number	:	1174454243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY RACINE DMD

Provider Business Mailing Address
First Line	:	3912 HILDA ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5547
Country	:	US
Telephone Number	:	703-508-9732
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 HIGHWAY 17 S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3117
Country	:	US
Telephone Number	:	843-888-2082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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