MEDICARE: DENTAL MANAGEMENT SERVICES, INC.

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	:	1346451119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL MANAGEMENT SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 7640
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-0015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 38TH AVE N
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-1313
Country	:	US
Telephone Number	:	843-448-5757
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. STACEY F BOWLES
Credential	:
Telephone Number	:	84434977111

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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