Healthcare Provider Details

I. General information

NPI: 1073041893
Provider Name (Legal Business Name): JOSEPH SPENCER WALLWORK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 HIGHWAY 81 N
ANDERSON SC
29621-3628
US

IV. Provider business mailing address

102 ELLICOTT HILL LN
SIMPSONVILLE SC
29681-6550
US

V. Phone/Fax

Practice location:
  • Phone: 864-760-1611
  • Fax:
Mailing address:
  • Phone: 814-746-6383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9801
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: