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General NPI Number Information
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NPI Number | 1689647307
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Entity Type | Individual
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Provider Name | WALTER PENNINGTON WITHERSPOON JR. DDS MSO
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Gender | Male
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 205 MEDICAL CIR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3653
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Country | US
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Telephone | 803-796-5300
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Fax | 803-796-5301
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Provider Business Mailing Address
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Address Line | 205 MEDICAL CIR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3653
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Country | US
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Telephone | 803-796-5300
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Fax | 803-796-5301
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1304
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 94
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1304
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 94
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License Number State | SC
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