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Individual

DR. LUCIUS FRANKLIN WATES

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
509 THURGOOD MARSHALL HWY, KINGSTREE, SC 29556-4107
(843) 355-9295
(843) 355-9296
Mailing address
509 THURGOOD MARSHALL HWY, KINGSTREE, SC 29556-4107
(843) 355-9295
(843) 355-9296

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1904
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
Z19043
SC
Enumeration date
01/06/2006
Last updated
07/08/2007
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