Provider Demographics
NPI:1093075939
Name:HORRY-GEORGETOWN TECHNICAL COLLEGE
Entity Type:Organization
Organization Name:HORRY-GEORGETOWN TECHNICAL COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, DEAN OF ACADEMIC AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:RENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-477-2171
Mailing Address - Street 1:PO BOX 261966
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-6066
Mailing Address - Country:US
Mailing Address - Phone:843-349-5279
Mailing Address - Fax:843-349-7532
Practice Address - Street 1:3500 PAMPAS DR
Practice Address - Street 2:BLDG. 1000
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5168
Practice Address - Country:US
Practice Address - Phone:843-349-5279
Practice Address - Fax:843-349-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty