Wallen, Jeffrey H

Wallen, Jeffrey H is an individual health care provider with primary practice located at 1200 48Th Ave N Suite 101, Myrtle Beach SC 29577-5425. He recently has only one registered license in Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery, which is considered as his primary health care specialty. Wallen, Jeffrey H can be contacted via phone (843) 449-4993.

Contact Information

Primary practice address
1200 48Th Ave N Suite 101 Myrtle Beach SC 29577-5425
Phone: (843) 449-4993
Fax: (843) 497-0647
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 2959 South Carolina

Profile Details

NPI number 1497729396
LBN Legal business name Wallen, Jeffrey H
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 15th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497729396 NPPES
South Carolina MEDICAID ZA9905
South Carolina MEDICAID 8998844

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