Individual
DR. KACY WONDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
173 ASHLEY AVENUE ROOM 453 MSC 507, CHARLESTON, SC 29425
(843) 729-0791
Mailing address
10 WESTEDGE STREET UNIT 302, CHARLESTON, SC 29403
(610) 468-5862
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
9435
SC
Other
Enumeration date
08/01/2019
Last updated
08/01/2019
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