Provider Demographics
NPI:1134188691
Name:SAULS, WILLIE JAMES JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:JAMES
Last Name:SAULS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-0895
Mailing Address - Country:US
Mailing Address - Phone:803-943-4895
Mailing Address - Fax:803-943-4895
Practice Address - Street 1:649 CAROLINA AVE WEST
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944
Practice Address - Country:US
Practice Address - Phone:803-943-4895
Practice Address - Fax:803-943-4895
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ21343Medicaid