MEDICARE: TGD-MT PLEASANT LLC

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	:	1437845781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TGD-MT PLEASANT LLC

Provider Business Mailing Address
First Line	:	PO BOX 306356
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6356
Country	:	US
Telephone Number	:	843-884-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 COLEMAN BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-4046
Country	:	US
Telephone Number	:	843-884-4340
Fax Number	:	843-884-1703

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES ERIC LAYTON
Credential	:	DMD
Telephone Number	:	843-884-4340

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	04/11/2023

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