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Lake Moultrie Dental Llc
Dental Clinic/Center in Moncks Corner, South Carolina
NPI 1013482603

Lake Moultrie Dental Llc is a Dental Clinic/Center based in Moncks Corner, SC and is specialized in Dental. Lake Moultrie Dental Llc practices in Moncks Corner, SC. The NPI Number for Lake Moultrie Dental Llc is 1013482603 and holds a License No. (South Carolina).

The current practice location address for Lake Moultrie Dental Llc is 205 Carolina Ave, Moncks Corner, SC and can be reached out via phone at 843-761-8720.

Location: 205 Carolina Ave, Moncks Corner, SC, 29461-3736
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1013482603
Provider Name
Lake Moultrie Dental Llc
Credential
Provider Entity Type
Organization
Address
205 Carolina Ave, Moncks Corner, SC, 29461-3736
Phone Number
843-761-8720
Fax Number
Provider Enumeration Date
10/10/2018
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
ZX8370 05 SC
institution
Provider Business Practice Location Address Details
Address
205 Carolina Ave
City
Moncks Corner
State
South Carolina
Zip
29461-3736
Phone Number
843-761-8720
Fax Number
person
Provider Business Mailing Address Details
Address
205 Carolina Ave
City
Moncks Corner
State
South Carolina
Zip
29461-3736
Phone Number
843-761-8720
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Dental
Taxonomy
261QD0000X
License No.
()
Definition
Definition to come...
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