Individual
DR. SCOTT C WIETECHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7033 SAINT ANDREWS RD, SUITE 102, COLUMBIA, SC 29212-1179
(803) 781-3321
(803) 781-4406
Mailing address
7033 SAINT ANDREWS RD, SUITE 102, COLUMBIA, SC 29212-1179
(803) 781-3321
(803) 781-4406
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2148
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148
DENTAL LICENSE
SC
05
—
ZZ2148
—
SC
Enumeration date
11/21/2006
Last updated
07/08/2007
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