Individual
WALLY T. AUSTELLE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
839 WAPPOO RD, CHARLESTON, SC 29407
(843) 556-4746
(843) 556-5435
Mailing address
839 WAPPOO RD, CHARLESTON, SC 29407
(843) 556-4746
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2473
SC
Other
Enumeration date
09/30/2011
Last updated
09/30/2011
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