Provider Demographics
NPI:1780705616
Name:CARDOZO, MICHAEL GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:CARDOZO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4999 CAROLINA FOREST BLVD STE 14
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3588
Mailing Address - Country:US
Mailing Address - Phone:843-903-4700
Mailing Address - Fax:843-903-4720
Practice Address - Street 1:4999 CAROLINA FOREST BLVD, SUITE 14
Practice Address - Street 2:
Practice Address - City:MRYTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-9998
Practice Address - Country:US
Practice Address - Phone:843-903-4700
Practice Address - Fax:843-903-4720
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice