Provider Demographics
NPI:1700339439
Name:WOOSTER, MARC (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:WOOSTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 BROWNS COVE RD STE A
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-7281
Mailing Address - Country:US
Mailing Address - Phone:843-645-7844
Mailing Address - Fax:
Practice Address - Street 1:591 BROWNS COVE RD STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7281
Practice Address - Country:US
Practice Address - Phone:843-645-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice