Individual
MARISSA ANN WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DME
Contact information
Practice address
10 MEDICAL PARK, PALMETTO HEALTH RICHLAND - DENTAL EDUC, COLUMBIA, SC 29203
(803) 434-6567
(803) 434-6299
Mailing address
10 MEDICAL PARK, PALMETTO HEALTH RICHLAND - DENTAL EDUC, COLUMBIA, SC 29203
(803) 434-6567
(803) 434-6299
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7134
SC
Other
Enumeration date
05/11/2012
Last updated
05/11/2012
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