Provider Demographics
NPI:1174254288
Name:DANIEL ISLAND FAMILY DENTAL
Entity Type:Organization
Organization Name:DANIEL ISLAND FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SEANNA
Authorized Official - Middle Name:MUIRE
Authorized Official - Last Name:MATTISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-410-4912
Mailing Address - Street 1:245 SEVEN FARMS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8500
Mailing Address - Country:US
Mailing Address - Phone:843-410-4912
Mailing Address - Fax:843-410-4913
Practice Address - Street 1:245 SEVEN FARMS DR STE 120
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8500
Practice Address - Country:US
Practice Address - Phone:843-410-4912
Practice Address - Fax:843-410-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty