| Wallace Periodontics, LLC | |
|
3 Professional Ct Sumter SC 29150-1927 | |
| (803) 294-4021 | |
| Not Available |
| Full Name | Wallace Periodontics, LLC |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3 Professional Ct, Sumter, South Carolina |
| Authorized Official Name and Position | Casey Castle (DIRECTOR OF PAYOR CONTRACTS) |
| Authorized Official Contact | 9127321504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wallace Periodontics, LLC 3 Professional Ct Sumter SC 29150-1927 | Wallace Periodontics, LLC 3 Professional Ct Sumter SC 29150-1927 Ph: (803) 294-4021 |
| NPI Number | 1164333555 |
|---|---|
| Provider Enumeration Date | 09/15/2026 |
| Last Update Date | 09/15/2026 |
| Certification Date | 09/15/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164333555 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (NU) | Primary |
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