Provider Demographics
NPI:1265933840
Name:DWC-P LLC
Entity type:Organization
Organization Name:DWC-P LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-445-5337
Mailing Address - Street 1:10104 FORD AVENUE
Mailing Address - Street 2:SUITE G
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324
Mailing Address - Country:US
Mailing Address - Phone:912-445-5337
Mailing Address - Fax:888-289-4301
Practice Address - Street 1:5209 PAULSEN STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-355-1512
Practice Address - Fax:912-355-1218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHTDMDLLC DBA DENTALWELLNESSCENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAD107471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty