Provider Demographics
NPI:1083775969
Name:HILTON HEAD DENTAL GROUP, P.A.
Entity Type:Organization
Organization Name:HILTON HEAD DENTAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-681-6200
Mailing Address - Street 1:400 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-4600
Mailing Address - Country:US
Mailing Address - Phone:843-681-6200
Mailing Address - Fax:843-681-8030
Practice Address - Street 1:400 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-4600
Practice Address - Country:US
Practice Address - Phone:843-681-6200
Practice Address - Fax:843-681-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty