Organization
WELVISTA
Active
Other names
Summerton Smiles for a Lifetime
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GEORGIA BENNETT FAMULINER (OPERATIONS DIRECTOR)
(803) 584-4803
Entity
Organization
Contact information
Practice address
9077 ALEX HARVIN HWY, SUMMERTON, SC 29148-9803
(803) 478-6277
(803) 478-6284
Mailing address
PO BOX 767, SUMMERTON, SC 29148-0767
(803) 478-6277
(803) 478-6284
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9502
—
SC
Enumeration date
10/23/2006
Last updated
09/20/2017
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