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General NPI Number Information
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NPI Number | 1023527348
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Entity Type | Organization
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Legal Business Name | WELVISTA
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 395 PINE ST E
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City | VARNVILLE
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State | SC
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Zip | 29944-9617
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Country | US
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Telephone | 803-300-7028
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Fax | 803-584-4806
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Provider Business Mailing Address
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Address Line | 395 PINE ST E
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City | VARNVILLE
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State | SC
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Zip | 29944-9617
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Country | US
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Telephone | 803-300-7028
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Fax | 803-584-4806
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Authorized Official
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Title or Position | SMILES OPERATIONS DIRECTOR
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Name | GEORGIA FAMULINER
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Credential | RN
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Telephone | 803-584-4803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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