Provider Demographics
NPI:1982036646
Name:WOOSTER DENTAL CARE PC
Entity Type:Organization
Organization Name:WOOSTER DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-645-7844
Mailing Address - Street 1:591 BROWNS COVE RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-7280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:591 BROWNS COVE RD
Practice Address - Street 2:UNIT A
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7280
Practice Address - Country:US
Practice Address - Phone:843-645-7844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC03360261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental