Provider Demographics
NPI:1902094402
Name:ANDREWS DENTAL CENTER INC
Entity Type:Organization
Organization Name:ANDREWS DENTAL CENTER INC
Other - Org Name:DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:JOHNATHAN
Authorized Official - Last Name:BECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-215-0579
Mailing Address - Street 1:PO BOX 2550
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2550
Mailing Address - Country:US
Mailing Address - Phone:843-215-0579
Mailing Address - Fax:843-215-0650
Practice Address - Street 1:429 E BROOKS RD
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-4041
Practice Address - Country:US
Practice Address - Phone:843-215-0579
Practice Address - Fax:843-215-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty