Healthcare Provider Details

I. General information

NPI: 1093003634
Provider Name (Legal Business Name): DWC-RH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 FORD AVE SUITE G2
RICHMOND HILL GA
31324-3992
US

IV. Provider business mailing address

10140 FORD AVE SUITE G2
RICHMOND HILL GA
31324-3992
US

V. Phone/Fax

Practice location:
  • Phone: 912-665-2792
  • Fax: 888-289-4301
Mailing address:
  • Phone: 912-665-2792
  • Fax: 888-289-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberGA 10747
License Number StateGA

VIII. Authorized Official

Name: MISS WILLIAM HOWARD TROUT JR.
Title or Position: MANAGING PARTNER
Credential: DMD
Phone: 912-665-2792