NPI 1013482603

Lake Moultrie Dental LLC

Organisation Dental Clinic/Center Moncks Corner, SC

Practice location

Address: 205 Carolina Ave, Moncks Corner, SC 29461-3736
Phone: (843) 761-8720

Authorised official

Name: Brian Lewis Jaques
Title: Owner/Dentist
Phone: (843) 761-8720

Registered specialties

Dental Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QD0000X

Other Clinic/Center providers in South Carolina →

Registry record

NPI: 1013482603
Entity type: Organization
NPI issued: 10 Oct 2018
Record last updated: 10 Oct 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.