MEDICARE: DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.

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	:	1225736978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.

Provider Business Mailing Address
First Line	:	8215 N KINGS HWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-3062
Country	:	US
Telephone Number	:	843-492-7580
Fax Number	:	843-492-7582

Provider Business Practice Location Address
First Line	:	8215 N KINGS HWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-3062
Country	:	US
Telephone Number	:	843-492-7580
Fax Number	:	843-492-7582

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	BELINDA HUERTA
Credential	:
Telephone Number	:	217-540-2100

Provider Enumeration Date	:	02/22/2023
Last Update Date	:	02/22/2023

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