Provider Demographics
NPI:1215083407
Name:STROUD, PAMELA S (RDH)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:STROUD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 HIGHWAY 917
Mailing Address - Street 2:
Mailing Address - City:NICHOLS
Mailing Address - State:SC
Mailing Address - Zip Code:29581-3068
Mailing Address - Country:US
Mailing Address - Phone:843-392-4837
Mailing Address - Fax:
Practice Address - Street 1:803 2ND AVE N
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3016
Practice Address - Country:US
Practice Address - Phone:843-249-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1137124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist