MEDICARE: SMILE DOCTORS 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1548759244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE DOCTORS OF SOUTH CAROLINA, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 674472
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-4472
Country	:	US
Telephone Number	:	706-886-1491
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 BEN CASEY DR STE 109
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8557
Country	:	US
Telephone Number	:	803-548-8110
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT V LAW
Credential	:	DMD
Telephone Number	:	706-886-1491

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	05/04/2022

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