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
- City
- Mt Pleasant
- State
- South Carolina
- 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 - Dental — Dental |
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