Provider Demographics
NPI:1205004520
Name:SANTEE DENTAL CARE
Entity Type:Organization
Organization Name:SANTEE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-563-3208
Mailing Address - Street 1:190 B PLAZA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:SC
Mailing Address - Zip Code:29142
Mailing Address - Country:US
Mailing Address - Phone:803-854-2600
Mailing Address - Fax:803-854-2660
Practice Address - Street 1:190 B PLAZA CIRCLE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29142
Practice Address - Country:US
Practice Address - Phone:803-854-2600
Practice Address - Fax:803-854-2660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM SCOTT GARRIS, D.M.D.,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty