Provider Demographics
NPI:1225760127
Name:BEACHY DENTAL PI LLC
Entity Type:Organization
Organization Name:BEACHY DENTAL PI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-860-3118
Mailing Address - Street 1:38 BLACKGUM RD UNIT G
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8495
Mailing Address - Country:US
Mailing Address - Phone:843-314-3006
Mailing Address - Fax:843-314-8037
Practice Address - Street 1:38 BLACKGUM RD UNIT G
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-8495
Practice Address - Country:US
Practice Address - Phone:843-314-3006
Practice Address - Fax:843-314-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty