Provider Demographics
NPI:1700311883
Name:MACHOWSKI, MARY (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:MACHOWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 BROOKGREEN DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5823
Mailing Address - Country:US
Mailing Address - Phone:843-448-4163
Mailing Address - Fax:
Practice Address - Street 1:13089 OCEAN HWY UNIT D4
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7140
Practice Address - Country:US
Practice Address - Phone:843-903-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91231223P0700X
NC121851223P0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program