Provider Demographics
NPI:1710365366
Name:HERITAGE DENTAL SPA AND SALON
Entity Type:Organization
Organization Name:HERITAGE DENTAL SPA AND SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-837-4444
Mailing Address - Street 1:32 MALPHRUS RD
Mailing Address - Street 2:STE 115
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6640
Mailing Address - Country:US
Mailing Address - Phone:843-837-4444
Mailing Address - Fax:
Practice Address - Street 1:32 MALPHRUS RD
Practice Address - Street 2:STE 115
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6640
Practice Address - Country:US
Practice Address - Phone:843-837-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3654261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental