MEDICARE: WELLNESS SMILES DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1821757105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS SMILES DENTISTRY

Provider Business Mailing Address
First Line	:	9789 CHARLOTTE HWY STE 400-227
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-7177
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8177 CHARLOTTE HIGHWAY
Second Line	:	SUITE 100
City	:	FORT MILL
State	:	SC
Zip	:	29707
Country	:	US
Telephone Number	:	347-339-2635
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. KEHINDE TOYIN AJAYI
Credential	:	DDS
Telephone Number	:	347-339-2635

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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