Organization
MARSHLANDS FAMILY DENTISTRY,PA
Active
Other names
Edward M Wise DMD
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGIE D GURGANIOUS (OFFICE MGR)
(843) 521-4344
Entity
Organization
Contact information
Practice address
1090 RIBAUT RD, BEAUFORT, SC 29902-5437
(843) 521-4344
(843) 521-1804
Mailing address
1090 RIBAUT RD, BEAUFORT, SC 29902-5437
(843) 521-4344
(843) 521-1804
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
Z1777
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1302242
UCCI
—
01
—
826791
UNITED CONCORDIA
—
01
—
829922
UNITED CONCORDIA
SC
05
—
Z17777
—
SC
05
—
ZA9852
—
SC
Enumeration date
08/16/2007
Last updated
10/27/2010
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