Individual
DR. WALTER PENNINGTON WITHERSPOON JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS MSO
Contact information
Practice address
205 MEDICAL CIR, WEST COLUMBIA, SC 29169-3653
(803) 796-5300
(803) 796-5301
Mailing address
205 MEDICAL CIR, WEST COLUMBIA, SC 29169-3653
(803) 796-5300
(803) 796-5301
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1304
SC
122300000X
Dentist
Primary
94
SC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
1304
SC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
94
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213041
DEPT OF HLTH & HUMAN SVS
SC
Enumeration date
02/13/2006
Last updated
09/11/2025
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