Provider Demographics
NPI:1003374414
Name:DENTAL WELLNESS CENTER OF SUMTER, LLC
Entity Type:Organization
Organization Name:DENTAL WELLNESS CENTER OF SUMTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-920-5577
Mailing Address - Street 1:PO BOX 60339
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31420-0339
Mailing Address - Country:US
Mailing Address - Phone:912-920-5577
Mailing Address - Fax:912-226-3489
Practice Address - Street 1:1322 BROAD ST STE 90
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1984
Practice Address - Country:US
Practice Address - Phone:803-883-0857
Practice Address - Fax:912-226-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1497918759OtherNPI
GADN010747OtherSTATE LICENSE