Provider Demographics
NPI:1508197724
Name:J.HAROLD CAPPS,JR., DMD,PC DBAGLENNS BAY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:J.HAROLD CAPPS,JR., DMD,PC DBAGLENNS BAY DENTAL ASSOCIATES
Other - Org Name:GLENNS BAY DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:CAPPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-650-5100
Mailing Address - Street 1:1625 GLENNS BAY RD
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4836
Mailing Address - Country:US
Mailing Address - Phone:843-650-5100
Mailing Address - Fax:843-650-0689
Practice Address - Street 1:1625 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4836
Practice Address - Country:US
Practice Address - Phone:843-650-5100
Practice Address - Fax:843-650-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1171681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty