Provider Demographics
NPI:1376622837
Name:MARKET COMMON DENTISTRY, PC
Entity Type:Organization
Organization Name:MARKET COMMON DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-293-6700
Mailing Address - Street 1:1342 FARROW PKWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1668
Mailing Address - Country:US
Mailing Address - Phone:843-293-6700
Mailing Address - Fax:843-293-6740
Practice Address - Street 1:1342 FARROW PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1668
Practice Address - Country:US
Practice Address - Phone:843-293-6700
Practice Address - Fax:843-293-6740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3124Medicaid
SCZX3124Medicaid