Provider Demographics
NPI:1053995027
Name:SEASIDE ORAL & MAXILLOFACIAL SURGERY INC
Entity type:Organization
Organization Name:SEASIDE ORAL & MAXILLOFACIAL SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAWHON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-669-7044
Mailing Address - Street 1:1967 HWY 17 BUSINESS
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:843-230-8261
Mailing Address - Fax:843-669-7052
Practice Address - Street 1:1967 HWY 17 BUSINESS
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-230-8261
Practice Address - Fax:843-669-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty