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NPI Code Detail

MEDICARE: DR. GORDON W WOMACK DDS

MEDICARE: DR. GORDON W WOMACK DDS
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
1122300000XDentistDGD.9455GDSC
2122300000XDentist17287OH
31223P0221XPediatric Dentistry17287OH
41223P0221XPediatric DentistryDGD.2025DSSC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2311367412OTHEROHFED TAX ID

General Provider Information

NPI Number : 1972600989
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GORDON W WOMACK DDS
Provider Business Mailing Address
First Line : 102 VIEW ST
Second Line :
City : MONCKS CORNER
State : SC
Zip : 29461-9783
Country : US
Telephone Number : 843-214-8040
Fax Number :
Provider Business Practice Location Address
First Line : 996 TANNER FORD BLVD
Second Line :
City : HANAHAN
State : SC
Zip : 29410-4780
Country : US
Telephone Number : 843-212-8810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 11/19/2024

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