Provider Demographics
NPI:1154644490
Name:LOWCOUNTRY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LOWCOUNTRY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD HONCHO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-651-6776
Mailing Address - Street 1:675 WACHESAW RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5681
Mailing Address - Country:US
Mailing Address - Phone:843-651-6776
Mailing Address - Fax:843-651-7487
Practice Address - Street 1:675 WACHESAW RD
Practice Address - Street 2:SUITE C
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5681
Practice Address - Country:US
Practice Address - Phone:843-651-6776
Practice Address - Fax:843-651-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC002276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty