MEDICARE: MRS. PAMELA S STROUD RDH

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	124Q00000X	Dental Hygienist	1137	SC

General Provider Information

NPI Number	:	1215083407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA S STROUD RDH

Provider Business Mailing Address
First Line	:	9735 HIGHWAY 917
Second Line	:
City	:	NICHOLS
State	:	SC
Zip	:	29581-3068
Country	:	US
Telephone Number	:	843-392-4837
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 2ND AVE N
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3016
Country	:	US
Telephone Number	:	843-249-1333
Fax Number	:

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

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	07/08/2007

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