Healthcare Provider Details

I. General information

NPI: 1508982281
Provider Name (Legal Business Name): PHILIP C. WILKINS, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N CONGRESS ST
WINNSBORO SC
29180-1119
US

IV. Provider business mailing address

124 N CONGRESS ST
WINNSBORO SC
29180-1119
US

V. Phone/Fax

Practice location:
  • Phone: 803-635-6162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2385
License Number StateSC

VIII. Authorized Official

Name: PHILIP WILKINS
Title or Position: DMD
Credential:
Phone: 803-635-6162