| Jeffrey H Wallen D.d.s. P.c. | |
|
1200 48th Ave N Ste 101 Myrtle Beach SC 29577-5423 | |
| (843) 449-4993 | |
| (843) 497-0647 |
| Full Name | Jeffrey H Wallen D.d.s. P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1200 48th Ave N Ste 101, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Jeffrey Hugh Wallen (OWNER) |
| Authorized Official Contact | 8434494993 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey H Wallen D.d.s. P.c. 1200 48th Ave N Ste 101 Myrtle Beach SC 29577-5423 Ph: (843) 449-4993 | Jeffrey H Wallen D.d.s. P.c. 1200 48th Ave N Ste 101 Myrtle Beach SC 29577-5423 Ph: (843) 449-4993 |
| NPI Number | 1134242621 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 06/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134242621 | NPI | - | NPPES |
| 8998844 | Other | NC | NORTH CAROLINA MEDICIAD |
| ZA9905 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2959 (South Carolina) | Primary |
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