Provider Demographics
NPI:1720144314
Name:SEASIDE SURGICAL, INC.
Entity type:Organization
Organization Name:SEASIDE SURGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIUD
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:BECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-492-4090
Mailing Address - Street 1:9256C HIGHWAY 17 BYPASS
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576
Mailing Address - Country:US
Mailing Address - Phone:843-492-4090
Mailing Address - Fax:843-215-0579
Practice Address - Street 1:9356C HIGHWAY 17 BYP
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9328
Practice Address - Country:US
Practice Address - Phone:843-492-4090
Practice Address - Fax:843-215-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2222261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental