Organization
WELVISTA
Active
Other names
Allendale Smiles for a Lifetime
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GEORGIA BENNETT FAMULINER (OPERATIONS DIRECTOR)
(803) 584-4803
Entity
Organization
Contact information
Practice address
3269 ALLENDALE FAIRFAX HWY, FAIRFAX, SC 29827-9163
(803) 584-4803
(803) 584-4806
Mailing address
PO BOX 221, ALLENDALE, SC 29810-0221
(803) 584-4803
(803) 584-4806
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9677
—
SC
Enumeration date
10/18/2006
Last updated
09/20/2017
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