Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lake Wylie Modern Dentistry, PC

Organization Dentist · NPI 1194376491

Lake Wylie Modern Dentistry, PC provides Dentist services in Lake Wylie, South Carolina. Registered with an NPI since 2019.

In the registry since
2019
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

140 Highway 274
Lake Wylie, SC 29710-6045
Phone: (803) 752-0565
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X

Record details

NPI number1194376491
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ali Shahrestani — Owner · (803) 752-0565
Other names Lake Wylie Modern Dentistry; Lake Wylie Modern Dentistry
NPI enumeratedSeptember 27, 2019
Last updated in NPPESJune 14, 2022
Certification dateJune 14, 2022
Mailing addressPo Box 920050, Dallas, TX 75392-0050

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