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General NPI Number Information
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NPI Number | 1619008547
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Entity Type | Organization
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Legal Business Name | GREENVILLE ORAL MAXILLOFACIAL SURGERY, P.A., A SOUTH CAROLINA PROFESSI
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 3929 S HIGHWAY 14
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City | GREENVILLE
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State | SC
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Zip | 29615-6138
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Country | US
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Telephone | 864-281-9119
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Fax | 864-281-9776
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Provider Business Mailing Address
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Address Line | 3929 S HIGHWAY 14
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City | GREENVILLE
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State | SC
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Zip | 29615-6138
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Country | US
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Telephone | 864-281-9119
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Fax | 864-281-9776
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES C WILSON
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Credential | DMD
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Telephone | 864-281-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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