NPIMap

Individual provider Active NPI

George Peter Sourlis, DMD

  • Dentist
  • North Myrtle Beach, SC
National Provider Identifier
1245753714
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8981 Issued in SC
Practice address
418 Main St
North Myrtle Beach, SC 29582-3041
Phone
(843) 249-7736
NPI assigned
Jul 17, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 8981 SC Primary

Addresses

Primary practice location

418 Main St
North Myrtle Beach, SC 29582-3041

Mailing address

3473 Bristol LN
Myrtle Beach, SC 29577-7517
Phone (443) 798-1875

Other practice location 1

3681 Spivey St
Loris, SC 29569-2838
Phone (843) 756-5747

Other practice location 2

3473 Bristol Ln
Myrtle Beach, SC 29577-7517
Phone (443) 798-1875

Other practice location 3

3473 Bristol Ln
Myrtle Beach, SC 29577-7517
Phone (443) 798-1875

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

Practice roles

OrganizationSpecialtyStatusNew patients
Loris Family Dentistry, LLC Dentist Past Accepting new patients
Forest Crossing Family Dental, LLC Past Accepting new patients
Dr Gwyn Gordon McCutchen Inc Dentist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1245753714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3473 BRISTOL LN",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295777517",
            "telephone_number": "443-798-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 MAIN ST",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295823041",
            "telephone_number": "843-249-7736"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3681 Spivey St",
            "address_purpose": "LOCATION",
            "city": "Loris",
            "state": "SC",
            "postal_code": "295692838",
            "country_code": "US",
            "telephone_number": "843-756-5747",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3473 Bristol Ln",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295777517",
            "country_code": "US",
            "telephone_number": "443-798-1875",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3473 Bristol Ln",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295777517",
            "country_code": "US",
            "telephone_number": "443-798-1875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOURLIS",
        "first_name": "GEORGE",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "8981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.