Provider Demographics
NPI:1316454689
Name:VAULE DENTAL CAROLINA WESMARK, LLC
Entity type:Organization
Organization Name:VAULE DENTAL CAROLINA WESMARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:
Authorized Official - Last Name:DULEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-328-1666
Mailing Address - Street 1:360 W WESMARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1977
Mailing Address - Country:US
Mailing Address - Phone:803-469-2060
Mailing Address - Fax:803-469-2073
Practice Address - Street 1:360 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1977
Practice Address - Country:US
Practice Address - Phone:803-469-2060
Practice Address - Fax:803-469-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty