MEDICARE: PARK WEST DENTISTRY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548274681	OTHER	SC	AMANDA SEAY
2	1497817001	OTHER	SC	ANTHONY MENNITO
3	1376773689	OTHER	SC	MELISSA MINGER

General Provider Information

NPI Number	:	1962127589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK WEST DENTISTRY

Provider Business Mailing Address
First Line	:	3404 SALTERBECK ST STE 202
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-7119
Country	:	US
Telephone Number	:	843-364-6720
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404 SALTERBECK ST STE 202
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-7119
Country	:	US
Telephone Number	:	843-375-0395
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. DAVID HERBERT SEAY
Credential	:
Telephone Number	:	843-364-6720

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	05/15/2023

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Directions to “PARK WEST DENTISTRY ” Practice Location

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