Lake Wylie Modern Dentistry, PC
Organization Active NPI Dentist · Lake Wylie, SC
NPI 1194376491 · NPPES record last updated Jun 14, 2022
Key facts
- NPI
- 1194376491
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- LAKE WYLIE MODERN DENTISTRY, PC
- Practice address
- 140 Highway 274
Lake Wylie, SC 29710-6045 - Phone
- (803) 752-0565
- NPI assigned
- Sep 27, 2019
- Organization subpart
- No
Authorized official
- Name
- Dr. Ali Shahrestani, DMD
- Title
- Owner
- Phone
- (803) 752-0565
Practitioners 6
-
Hussam Ahmed, D.M.D, M.S.
-
Peter Clifford Shatz, D.D.S.
National Provider Directory
Locations
140 Highway 274
Lake Wylie, SC 29710
Phone (803) 752-0565
158 Highway 274
Ste 10A
Lake Wylie, SC 29710
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | Yes |
Addresses
Primary practice location
140 Highway 274
Lake Wylie, SC 29710-6045
Mailing address
PO Box 920050
Dallas, TX 75392-0050
Other names
- Lake Wylie Modern Dentistry
Other providers in Lake Wylie, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.