| Welvista | |
|
3269 Allendale Fairfax Hwy Fairfax SC 29827-9163 | |
| (803) 584-4803 | |
| (803) 584-4806 |
| Full Name | Welvista |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3269 Allendale Fairfax Hwy, Fairfax, South Carolina |
| Authorized Official Name and Position | Georgia Bennett Famuliner (OPERATIONS DIRECTOR) |
| Authorized Official Contact | 8035844803 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Welvista Po Box 221 Allendale SC 29810-0221 Ph: (803) 584-4803 | Welvista 3269 Allendale Fairfax Hwy Fairfax SC 29827-9163 Ph: (803) 584-4803 |
| NPI Number | 1033290937 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 09/20/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033290937 | NPI | - | NPPES |
| ZA9677 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Robert M. Haberkorn Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1987 Allendale Fairfax Hwy., Fairfax, SC 29827 Phone: 803-632-3301 | |
Spencer B Wagner Dmd Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1987 Allendale Fairfax Hwy, Fairfax, SC 29827 Phone: 803-632-3301 Fax: 803-632-1240 |