Provider Demographics
NPI:1417386707
Name:WANDO FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:WANDO FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:
Authorized Official - First Name:VHERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-509-5355
Mailing Address - Street 1:3377 S MORGANS POINT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8332
Mailing Address - Country:US
Mailing Address - Phone:843-972-9700
Mailing Address - Fax:
Practice Address - Street 1:3377 S MORGANS POINT RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8332
Practice Address - Country:US
Practice Address - Phone:843-972-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty