Provider Demographics
NPI:1114551058
Name:DENTAL WELLNESS CENTER EB5 VI LLC
Entity Type:Organization
Organization Name:DENTAL WELLNESS CENTER EB5 VI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-599-9590
Mailing Address - Street 1:749 STOCKBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7200
Mailing Address - Country:US
Mailing Address - Phone:803-335-5585
Mailing Address - Fax:803-335-0515
Practice Address - Street 1:1988 PAXVILLE HWY
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-6432
Practice Address - Country:US
Practice Address - Phone:803-433-4600
Practice Address - Fax:803-433-4601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL WELLNESS CENTER EB5 VI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty