Active NPI
Brock Dwyer
- Dentist
- Myrtle Beach, SC
National Provider Identifier
1063308294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 111555
- Practice address
- 1209 N Retail CT
Myrtle Beach, SC 29577-9626 - Phone
- (843) 874-4060
- NPI assigned
- Jun 16, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 111555 | SC | Primary |
Addresses
Primary practice location
1209 N Retail CT
Myrtle Beach, SC 29577-9626
Mailing address
902 W 2ND Ave
Windermere, FL 34786-8517
Phone (407) 697-9349
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111555 | SC | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jebediah S. Christy, DDS - Myrtle Beach PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Myrtle Beach, SC
- NPI 1518336924
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750032000000",
"number": "1063308294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "902 W 2ND AVE",
"city": "WINDERMERE",
"state": "FL",
"postal_code": "347868517",
"telephone_number": "407-697-9349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1209 N RETAIL CT",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295779626",
"telephone_number": "843-874-4060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DWYER",
"first_name": "BROCK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-06-16",
"last_updated": "2025-06-16",
"certification_date": "2025-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "111555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.