Longboard Dental LLC

NPI #1134837503 in Mt Pleasant, South Carolina

Provider Information

NPI Number
1134837503
Entity Type
Organization
Organization Name
Longboard Dental LLC
Primary Specialty
Clinic/Center - Dental
Enumeration Date
Nov 14, 2022
Last Updated
Nov 14, 2022

Practice Location

Address
405 FAISON ROAD
Address 2
SUIRE A3
ZIP Code
29466
Phone
(843) 654-1373

Authorized Official

Name
DR. ELLEN PAULISICK WOLF, DDS, FAGD
Title
DENTIST
Phone
(843) 654-1373

Specialties & Taxonomy Codes

Specialty
Clinic/Center - DentalDental

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