Organization
FOREST ACRES DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH BRYAN WINGATE JR. DMD (PARTNER)
(803) 792-0965
Entity
Organization
Contact information
Practice address
5211 N TRENHOLM RD, SUITE A, COLUMBIA, SC 29206-4815
(803) 782-0965
(803) 782-3404
Mailing address
5211 N TRENHOLM RD, SUITE A, COLUMBIA, SC 29206-4815
(803) 782-0965
(803) 782-3404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1924
SC
1223G0001X
General Practice Dentistry
8220
SC
1223G0001X
General Practice Dentistry
Primary
8221
SC
Other
Enumeration date
01/06/2014
Last updated
01/06/2014
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