Provider Demographics
NPI:1497638456
Name:PREMIER SMILE AND IMPLANT CENTER
Entity type:Organization
Organization Name:PREMIER SMILE AND IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WALSH
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-903-1731
Mailing Address - Street 1:10225 OCEAN HWY UNIT 203
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6507
Mailing Address - Country:US
Mailing Address - Phone:843-314-0866
Mailing Address - Fax:
Practice Address - Street 1:10225 OCEAN HWY UNIT 203
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6507
Practice Address - Country:US
Practice Address - Phone:843-314-0866
Practice Address - Fax:843-314-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory