Organization
MARSHLANDS II FAMILY DENTISTRY, PA
Active
Other names
Marshlands Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN DAVID SOUTHERLAND WISE DMD (GENERAL DENTIST)
(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
261QD0000X
Dental Clinic/Center
Primary
4601
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134233935
NPI
SC
01
—
1548499635
NPI
SC
05
—
Z17777
—
SC
05
—
ZX4601
—
SC
Enumeration date
02/13/2018
Last updated
02/13/2018
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