MEDICARE: KELLY SCHWEERS DMD, MSD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10080	SC

General Provider Information

NPI Number	:	1518719830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY SCHWEERS DMD, MSD

Provider Business Mailing Address
First Line	:	395 BUCK DR
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-6992
Country	:	US
Telephone Number	:	803-603-3553
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 CADUCEUS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-2902
Country	:	US
Telephone Number	:	843-293-3522
Fax Number	:

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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