Organization
PENINSULA COSMETIC AND FAMILY DENTISTRY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES BRADLEY WISNER D.M.D. (PRESIDENT)
(843) 722-1676
Entity
Organization
Contact information
Practice address
52 COURTENAY DR, CHARLESTON, SC 29403-5707
(843) 722-1676
Mailing address
52 COURTENAY DR, CHARLESTON, SC 29403-5707
(843) 722-1676
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3916
SC
Other
Enumeration date
12/12/2006
Last updated
08/22/2020
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