Provider Demographics
NPI:1316520760
Name:NEW SMILE SHOPPE LLC
Entity type:Organization
Organization Name:NEW SMILE SHOPPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-314-3006
Mailing Address - Street 1:38 BLACKGUM ROAD
Mailing Address - Street 2:SUITE G
Mailing Address - City:PAWLEYS ISL
Mailing Address - State:SC
Mailing Address - Zip Code:29585
Mailing Address - Country:US
Mailing Address - Phone:843-314-3006
Mailing Address - Fax:843-314-8037
Practice Address - Street 1:1051 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-388-9690
Practice Address - Fax:843-388-9703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DENTAL IMPLANT CENTRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1144498213OtherDENTISTRY