Provider Demographics
NPI:1376306878
Name:PENINSULA DENTISTRY WAPPOO LLC
Entity Type:Organization
Organization Name:PENINSULA DENTISTRY WAPPOO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WISNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-460-5206
Mailing Address - Street 1:839 WAPPOO RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5866
Mailing Address - Country:US
Mailing Address - Phone:843-556-4746
Mailing Address - Fax:
Practice Address - Street 1:839 WAPPOO RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5866
Practice Address - Country:US
Practice Address - Phone:843-556-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental