MEDICARE: PORT ROYAL ORAL SURGERY PA

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	03964	SC

General Provider Information

NPI Number	:	1437365996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT ROYAL ORAL SURGERY PA

Provider Business Mailing Address
First Line	:	14 MARSHELLEN DR # B
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6900
Country	:	US
Telephone Number	:	843-729-5409
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 MARSHELLEN DR # B
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6900
Country	:	US
Telephone Number	:	834-729-5409
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DR. SIMONS HANE JR.
Credential	:	DMD
Telephone Number	:	843-729-5409

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1700876893 — DANIEL C RIPLEY MD
Practice Location Address:

10 MARSH ELLEN DR
BEAUFORT, SC
29902-6900

Practice Phone: 843-525-9015
Practice Fax: 843-525-9020

1063491025 — ERIC DEAN GEARHART PA
Practice Location Address:

10A MARSHELLEN DR
BEAUFORT, SC
29902-6900

Practice Phone: 843-525-9015
Practice Fax: 843-525-9020

1205888765 — DR. KAREN MICHELLE ELLER M.D.
Practice Location Address:

41A MARSHELLEN DR , PALMETTO PAIN PA
BEAUFORT, SC
29902-6900

Practice Phone: 843-522-3456
Practice Fax: 843-522-8263

1154333607 — BEAUFORT FAMILY CARE LLC
Practice Location Address:

10A MARSHELLEN DR
BEAUFORT, SC
29902-6900

Practice Phone: 843-525-9015
Practice Fax: 843-525-9020

1275618332 — PALMETTO PAIN CENTER PA
Practice Location Address:

41 MARSHELLEN DR , SUITE A
BEAUFORT, SC
29902-6900

Practice Phone: 843-522-3456
Practice Fax: 843-522-8263

1073650768 — I.V. SPECIALISTS, INC.
Practice Location Address:

25B MARSHELLEN DR
BEAUFORT, SC
29902-6900

Practice Phone: 843-524-3777
Practice Fax: 843-524-3776

1073658506 — KELLY R MARCONYAK SLP
Practice Location Address:

14 MARSHELLEN DR
BEAUFORT, SC
29902-6900

Practice Phone: 843-579-8333
Practice Fax:

Directions to “PORT ROYAL ORAL SURGERY PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.