MEDICARE: DR. CHRISTOPHER HEATH WINE DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	4676	SC
2	1223P0700X	Prosthodontics	DN015271	GA

General Provider Information

NPI Number	:	1841487352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER HEATH WINE DDS, MS

Provider Business Mailing Address
First Line	:	4 OKATIE CENTER BLVD S
Second Line	:	SUITE 103
City	:	OKATIE
State	:	SC
Zip	:	29909-7529
Country	:	US
Telephone Number	:	843-705-9551
Fax Number	:	843-705-9552

Provider Business Practice Location Address
First Line	:	4 OKATIE CENTER BLVD S
Second Line	:	SUITE 103
City	:	OKATIE
State	:	SC
Zip	:	29909-7529
Country	:	US
Telephone Number	:	843-705-9551
Fax Number	:	843-705-9552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	03/15/2017

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