| Carolina Family Dentistry At Lake Wylie | |
|
244 Latitude Ln Ste 103 Lake Wylie SC 29710-8125 | |
| (803) 831-2171 | |
| (803) 831-2172 |
| Full Name | Carolina Family Dentistry At Lake Wylie |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 244 Latitude Ln Ste 103, Lake Wylie, South Carolina |
| Authorized Official Name and Position | Vanessa N. Vargas (OWNER/ DENTIST) |
| Authorized Official Contact | 8038312171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolina Family Dentistry At Lake Wylie 244 Latitude Ln Ste 103 Lake Wylie SC 29710-8125 Ph: (803) 831-2171 | Carolina Family Dentistry At Lake Wylie 244 Latitude Ln Ste 103 Lake Wylie SC 29710-8125 Ph: (803) 831-2171 |
| NPI Number | 1629749106 |
|---|---|
| Provider Enumeration Date | 09/23/2021 |
| Last Update Date | 09/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629749106 | NPI | - | NPPES |
| 1639539653 | Other | SC | DENTIST |
| 1528635604 | Other | SC | DENTIST |
| 1083818157 | Other | SC | DENTIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Lake Wylie Modern Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 140 Highway 274, Lake Wylie, SC 29710 Phone: 803-752-0565 | |
Dr Thomas N Stall Dmd Or Dr Stacy L Blackmon Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1100 Village Harbor Dr, Lake Wylie, SC 29710 Phone: 803-831-8856 Fax: 803-831-8966 |