Provider Demographics
NPI:1508069006
Name:WOOLEY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WOOLEY FAMILY DENTISTRY
Other - Org Name:AMANDA GREGORY FAMILY COSMETIC DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-871-9924
Mailing Address - Street 1:7455 CROSS COUNTRY RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483
Mailing Address - Country:US
Mailing Address - Phone:843-552-4771
Mailing Address - Fax:843-552-6192
Practice Address - Street 1:1223 BOONEHILL RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-871-9924
Practice Address - Fax:843-871-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8338Medicaid