Provider Demographics
NPI:1467837062
Name:INLET PREMIER IMPLANT & COSMETIC DENTISTRY
Entity type:Organization
Organization Name:INLET PREMIER IMPLANT & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAUREAN
Authorized Official - Middle Name:JERMAINE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-421-3198
Mailing Address - Street 1:9356 HIGHWAY 17 BYP
Mailing Address - Street 2:SUITE C
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9328
Mailing Address - Country:US
Mailing Address - Phone:843-421-3198
Mailing Address - Fax:188-490-5080
Practice Address - Street 1:9356 HIGHWAY 17 BYP
Practice Address - Street 2:SUITE C
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9328
Practice Address - Country:US
Practice Address - Phone:843-421-3198
Practice Address - Fax:188-490-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4675Medicaid