Provider Demographics
NPI:1184320616
Name:HAMPTON DENTISTRY, LLC
Entity type:Organization
Organization Name:HAMPTON DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMERSON
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:GOWER
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-621-1104
Mailing Address - Street 1:649 W CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:VARNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29944-4757
Mailing Address - Country:US
Mailing Address - Phone:803-943-4895
Mailing Address - Fax:803-573-1018
Practice Address - Street 1:2015 BOUNDARY ST STE 104
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6803
Practice Address - Country:US
Practice Address - Phone:843-621-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMPTON DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-06
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental