Surfside Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1693 Issued in SC

Legal business name

SURFSIDE DENTAL LLC

Doing business as

Surfside Family Dentistry

Practice address

1665 Glenns Bay Rd
Surfside Beach, SC 29575-4836

Phone

(843) 215-6080

Fax

(888) 636-7841

NPI assigned

Dec 19, 2011

Last updated

Dec 19, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Scott J Willis

Title

Member

Phone

(843) 652-0011

Specialties & licenses 1

Addresses

Other names 1

• SURFSIDE FAMILY DENTISTRY Doing business as

Locations

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324252800000",
    "number": "1316216500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11919 PLAZA DR",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295769356",
            "telephone_number": "843-652-0011",
            "fax_number": "888-636-7841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 GLENNS BAY RD",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295754836",
            "telephone_number": "843-215-6080",
            "fax_number": "888-636-7841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURFSIDE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-19",
        "last_updated": "2011-12-19",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "843-652-0011"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "1693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SURFSIDE FAMILY DENTISTRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gwendolyn G Strickland, P.A.
• Stuart P. Creson Inc
• Surfside Beach Rescue Squad
• Surfside Beach Urgent Care LLC
• Surfside Counseling, LLC
• Surfside SW LLC (Surfside Smiles)
• Susan Edwards Surratt, FNP
• Autumn Tami, PHARMD
• Cameron James Tansey, DMD
• Telenutrition Therapy

• General Practice Dentistry in Surfside Beach, SC
• Providers in Surfside Beach, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.