Provider Demographics
NPI:1386734804
Name:ADVANCED DENTAL SOLUTIONS, LLC
Entity type:Organization
Organization Name:ADVANCED DENTAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:GUDZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-785-4801
Mailing Address - Street 1:32 OFFICE PARK RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4637
Mailing Address - Country:US
Mailing Address - Phone:843-785-4801
Mailing Address - Fax:843-785-7804
Practice Address - Street 1:32 OFFICE PARK RD
Practice Address - Street 2:SUITE 207
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-4637
Practice Address - Country:US
Practice Address - Phone:843-785-4801
Practice Address - Fax:843-785-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC33191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty