Provider Demographics
NPI:1255529947
Name:HAEFNER, WENDY S (DDS)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:S
Last Name:HAEFNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 APPLING DR
Mailing Address - Street 2:UNIT 202
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4879
Mailing Address - Country:US
Mailing Address - Phone:843-513-5248
Mailing Address - Fax:
Practice Address - Street 1:1571 MATHIS FERRY RD
Practice Address - Street 2:MATHIS FERRY DENTISTRY
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9703
Practice Address - Country:US
Practice Address - Phone:843-884-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice