Provider Demographics
NPI:1437966546
Name:WATEREE FAMILY DENTISTRY
Entity type:Organization
Organization Name:WATEREE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:V
Authorized Official - Last Name:MONFERDINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-438-1845
Mailing Address - Street 1:947 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9178
Mailing Address - Country:US
Mailing Address - Phone:803-438-1845
Mailing Address - Fax:803-438-6292
Practice Address - Street 1:947 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9178
Practice Address - Country:US
Practice Address - Phone:803-438-1845
Practice Address - Fax:803-438-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental