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Organization
CAROLINA OMS LLC
Active
Organization
CAROLINA OMS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS WEGNER DMD (SURGEON/CO-OWNER)
(803) 548-9910
Entity
Organization
Contact information
Practice address
105 BEN CASEY DR STE 115, FORT MILL, SC 29708-8557
(803) 548-9910
(803) 548-9915
Mailing address
105 BEN CASEY DR STE 115, FORT MILL, SC 29708-8557
(803) 548-9910
(803) 548-9915
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801976162
KENNETH BURTNER
—
Enumeration date
05/19/2023
Last updated
06/01/2023
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