Provider Demographics
NPI:1922265610
Name:MICHAEL JACOB WEHMAN D.M.D., P.A.
Entity Type:Organization
Organization Name:MICHAEL JACOB WEHMAN D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:WEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-776-2955
Mailing Address - Street 1:801 TRUE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1635
Mailing Address - Country:US
Mailing Address - Phone:803-776-2955
Mailing Address - Fax:803-776-3200
Practice Address - Street 1:801 TRUE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1635
Practice Address - Country:US
Practice Address - Phone:803-776-2955
Practice Address - Fax:803-776-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty