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General NPI Number Information
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NPI Number | 1811378540
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Entity Type | Individual
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Provider Name | MARK WILLIAM WANINGER JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 MARKET
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City | BEAUFORT
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State | SC
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Zip | 29906-9107
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Country | US
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Telephone | 843-240-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MARKET
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City | BEAUFORT
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State | SC
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Zip | 29906-9107
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Country | US
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Telephone | 843-379-1007
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Fax |
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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 | 8564
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8564
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License Number State | SC
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