Provider Demographics
NPI:1083863633
Name:HALTERMAN, SANDRA M (OS, DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:HALTERMAN
Suffix:
Gender:F
Credentials:OS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0547
Mailing Address - Country:US
Mailing Address - Phone:843-663-8000
Mailing Address - Fax:843-663-8166
Practice Address - Street 1:4220 CAROLINA EXCHANGE DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4220
Practice Address - Country:US
Practice Address - Phone:843-663-8000
Practice Address - Fax:843-663-8166
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94731223G0001X
SC20261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice