Provider Demographics
NPI:1700859733
Name:CHILDS, MARY ANN (DMD)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:CHILDS
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 1:21 NEW ORLEANS RD STE A
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4797
Mailing Address - Country:US
Mailing Address - Phone:864-233-4166
Mailing Address - Fax:843-785-8206
Practice Address - Street 1:21 NEW ORLEANS RD STE A
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4797
Practice Address - Country:US
Practice Address - Phone:843-785-6285
Practice Address - Fax:843-785-8206
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3694332B00000X, 332BC3200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment