Organization
PENINSULA COSMETIC AND FAMILY DENTISTRY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES BRADLEY WISNER DMD (OWNER/DENTIST)
(843) 722-1676
Entity
Organization
Contact information
Practice address
538 SAVANNAH HWY, CHARLESTON, SC 29407-7210
(843) 722-1676
Mailing address
538 SAVANNAH HWY, CHARLESTON, SC 29407-7210
(843) 722-1676
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/02/2020
Last updated
10/13/2020
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