MEDICARE: ST. JAMES DENTISTRY, 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	122300000X	Dentist	4356	SC

General Provider Information

NPI Number	:	1760700157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JAMES DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	9403 HIGHWAY 707
Second Line	:	SUITE D
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7758
Country	:	US
Telephone Number	:	843-650-2000
Fax Number	:	843-650-2007

Provider Business Practice Location Address
First Line	:	9403 HIGHWAY 707
Second Line	:	SUITE D
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7758
Country	:	US
Telephone Number	:	843-650-2000
Fax Number	:	843-650-2007

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KATHERIN CATLETT
Credential	:
Telephone Number	:	843-650-2000

Provider Enumeration Date	:	05/10/2010
Last Update Date	:	05/10/2010

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