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Organization
PENINSULA COSMETIC AND FAMILY DENTISTRY, INC.
Active
Organization
PENINSULA COSMETIC AND FAMILY DENTISTRY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES BRADLEY WISNER D.M.D. (PRESIDENT)
(843) 722-1676
Entity
Organization
Contact information
Practice address
52 COURTENAY DR, CHARLESTON, SC 29403-5707
(843) 722-1676
Mailing address
52 COURTENAY DR, CHARLESTON, SC 29403-5707
(843) 722-1676
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3916
SC
Other
Enumeration date
12/12/2006
Last updated
08/22/2020
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