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General NPI Number Information
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NPI Number | 1417127028
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Entity Type | Organization
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Legal Business Name | DAVIS AND WINE DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 4 OKATIE CENTER BLVD SOUTH SUITE 103
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City | OKATIE
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State | SC
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Zip | 29909
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Country | US
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Telephone | 843-705-9551
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Fax | 843-705-9552
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Provider Business Mailing Address
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Address Line | 4 OKATIE CENTER BLVD SOUTH SUITE 103
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City | OKATIE
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State | SC
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Zip | 29909
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Country | US
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Telephone | 843-705-9551
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Fax | 843-705-9552
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER H WINE
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Credential | D.D.S., MS
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Telephone | 843-705-9551
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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 | 8091
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN013298
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1717
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4583
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License Number State | SC
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Taxonomy #5
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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 | SC
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Taxonomy #6
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State | SC
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Taxonomy #8
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 4182
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License Number State | SC
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Taxonomy #9
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 4676
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License Number State | SC
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Taxonomy #10
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN015271
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License Number State | GA
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Taxonomy #11
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State | GA
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Taxonomy #12
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State | SC
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Taxonomy #13
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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 | GA
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