Provider Demographics
NPI:1841487352
Name:WINE, CHRISTOPHER HEATH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:HEATH
Last Name:WINE
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:4 OKATIE CENTER BLVD S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7529
Mailing Address - Country:US
Mailing Address - Phone:843-705-9551
Mailing Address - Fax:843-705-9552
Practice Address - Street 1:4 OKATIE CENTER BLVD S
Practice Address - Street 2:SUITE 103
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7529
Practice Address - Country:US
Practice Address - Phone:843-705-9551
Practice Address - Fax:843-705-9552
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC46761223P0700X
GADN0152711223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics