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General NPI Number Information
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NPI Number | 1386929271
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Entity Type | Organization
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Legal Business Name | FAIRFIELD FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 123 US HIGHWAY 321 BYP S
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City | WINNSBORO
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State | SC
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Zip | 29180-7047
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Country | US
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Telephone | 803-815-1077
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Fax | 803-815-0098
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Provider Business Mailing Address
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Address Line | 123 US HIGHWAY 321 BYP S
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City | WINNSBORO
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State | SC
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Zip | 29180-7047
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Country | US
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Telephone | 803-815-1077
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Fax | 803-815-0098
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. NEIL THOMAS WRENN
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Credential | D.M.D.
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Telephone | 803-815-1077
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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 | 6989
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License Number State | SC
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