1346723061 NPI number — WALTON DRIVE DENTAL HEALTH CLINIC, PC

Table of content: (NPI 1346723061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346723061 NPI number — WALTON DRIVE DENTAL HEALTH CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALTON DRIVE DENTAL HEALTH CLINIC, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346723061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 DELBOURNE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29651-7196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 HIGHWAY 17 UNIT B5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576-6434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-557-5396
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CHARLES
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
843-557-5396

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com