Individual
DR. KEITH STANLEY WICKIZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.S., A.B.O.
Contact information
Practice address
100 OMALLEY DR UNIT B, SUMMERVILLE, SC 29483-5635
(843) 261-0142
(843) 261-0125
Mailing address
100 OMALLEY DR UNIT B, SUMMERVILLE, SC 29483-5635
(843) 261-0142
(843) 261-0125
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4227
SC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0657
SC
Other
Enumeration date
10/13/2005
Last updated
04/15/2008
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