Provider Demographics
NPI:1922546506
Name:ACUITY DENTISTRY AND ORTHODONTICS
Entity Type:Organization
Organization Name:ACUITY DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:WICKIZER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:843-261-2001
Mailing Address - Street 1:953 ORANGEBURG RD STE A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-8941
Mailing Address - Country:US
Mailing Address - Phone:843-261-2001
Mailing Address - Fax:
Practice Address - Street 1:953 ORANGEBURG RD STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-8941
Practice Address - Country:US
Practice Address - Phone:843-261-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty