Provider Demographics
NPI:1245612712
Name:WYRICK, SARAH AMELIA (DMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:AMELIA
Last Name:WYRICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3010
Mailing Address - Country:US
Mailing Address - Phone:864-282-1935
Mailing Address - Fax:864-282-1955
Practice Address - Street 1:4328 WADE HAMPTON BLVD
Practice Address - Street 2:SUITE #F
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2252
Practice Address - Country:US
Practice Address - Phone:864-244-1494
Practice Address - Fax:864-282-1955
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD. 8575 GD1223G0001X
FLDN 213361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice