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General NPI Number Information
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NPI Number | 1316563133
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Entity Type | Individual
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Provider Name | TODD GARRETT WOOLLEN DMD
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Gender | Male
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 272 CEDAR SPRINGS RD
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City | SPARTANBURG
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State | SC
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Zip | 29302-4643
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Country | US
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Telephone | 864-583-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 145 MOORE DAIRY RD
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City | MOORE
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State | SC
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Zip | 29369-9681
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 9651
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License Number State | SC
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