Provider Demographics
NPI:1336787811
Name:DENTAL WELLNESS CENTER EB5 INVESTMENT VI LLC
Entity type:Organization
Organization Name:DENTAL WELLNESS CENTER EB5 INVESTMENT VI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-599-9590
Mailing Address - Street 1:2724 N LAKE DR STE 304
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8733
Mailing Address - Country:US
Mailing Address - Phone:803-708-1531
Mailing Address - Fax:803-708-1531
Practice Address - Street 1:2724 N LAKE DR STE 304
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8733
Practice Address - Country:US
Practice Address - Phone:803-708-1531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL WELLNESS CENTER EB5 INVESTMENT VI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-16
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty