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General NPI Number Information
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NPI Number | 1376903781
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Entity Type | Organization
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Legal Business Name | TRUE STREET DENTAL
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 801 TRUE ST
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City | COLUMBIA
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State | SC
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Zip | 29209-1635
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Country | US
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Telephone | 803-776-2955
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Fax | 803-776-3200
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Provider Business Mailing Address
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Address Line | 801 TRUE ST
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City | COLUMBIA
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State | SC
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Zip | 29209-1635
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Country | US
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Telephone | 803-776-2955
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Fax | 803-776-3200
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL J WEHMAN
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Credential |
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Telephone | 803-776-2955
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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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