Healthcare Provider Details

I. General information

NPI: 1568806388
Provider Name (Legal Business Name): DWC-SAV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14045 ABERCORN ST SUITE 2403
SAVANNAH GA
31419-1957
US

IV. Provider business mailing address

10104 FORD AVE STE G
RICHMOND HILL GA
31324-8849
US

V. Phone/Fax

Practice location:
  • Phone: 912-445-5337
  • Fax:
Mailing address:
  • Phone: 912-445-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10747
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM HOWARD TROUT JR.
Title or Position: OWNER/ MANAGER
Credential: DMD
Phone: 912-445-5337