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Organization
WELVISTA
Active
Organization
WELVISTA
Active
Other names
Dillon Two Smiles for a Lifetime
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GEORGIA BENNETT FAMULINER (OPERATIONS DRIECTOR)
(803) 584-4803
Entity
Organization
Contact information
Practice address
1730A HIGHWAY 301 N, DILLON, SC 29536-1950
(843) 774-6200
(843) 774-6283
Mailing address
PO BOX 1502, DILLON, SC 29536-1502
(843) 774-6200
(843) 774-6283
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9609
—
SC
Enumeration date
10/18/2006
Last updated
09/20/2017
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