Organization
CAROLINA FAMILY DENTISTRY AT LAKE WYLIE
Active
Parent organization
CAROLINA FAMILY DENTISTRY AT LAKE WYLIE
Other names
Carolina Family Dentistry at Rock Hill
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROLINA FAMILY DENTISTRY AT LAKE WYLIE
Authorized official
DR. VANESSA N. VARGAS DMD (OWNER/ DENTIST)
(803) 831-2171
Entity
Organization
Contact information
Practice address
244 LATITUDE LN STE 103, LAKE WYLIE, SC 29710-8125
(803) 831-2171
(803) 831-2172
Mailing address
244 LATITUDE LN STE 103, LAKE WYLIE, SC 29710-8125
(803) 831-2171
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083818157
DENTIST
SC
01
—
1528635604
DENTIST
SC
01
—
1639539653
DENTIST
SC
Enumeration date
09/23/2021
Last updated
09/23/2021
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