WELVISTA (NPI# 1033290937) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033290937 |
| Entity Type | Organization |
| Organization Name | WELVISTA |
| Other Organization Name | ALLENDALE SMILES FOR A LIFETIME |
| Practice Address |
3269 Allendale Fairfax Hwy Fairfax SC 29827-9163 |
| Mailing Address |
Po Box 221 Allendale SC 29810-0221 |
| Practice Telephone | 8035844803 |
| Practice Fax Number | 8035844806 |
| Mailing Telephone | 8035844803 |
| Mailing Fax Number | 8035844806 |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2017-09-20 |
| Authorized Official Name | MRS. GEORGIA BENNETT FAMULINER (OPERATIONS DIRECTOR) |
| Authorized Official Telephone | 8035844803 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | ZA9677 | 05 |
| Other Name | Type Code |
|---|---|
| Allendale Smiles for a Lifetime | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023527348 | Welvista | Dentist | 395 Pine St E, Varnville, SC 29944-9617 | 2017-09-29 |
| 1861796518 | Welvista | Pharmacy | 2700 Middleburg Drive, Suite 104, Columbia, SC 29204 | 2011-01-10 |
| 1023200441 | Welvista | Pharmacy | 2700 Middleburg Dr Ste 108, Columbia, SC 29204-2416 | 2007-08-10 |
| 1386727188 | Welvista | Dentist | 9077 Alex Harvin Hwy, Summerton, SC 29148-9803 | 2006-10-23 |
| 1922189885 | Welvista | Dentist | 1730a Highway 301 N, Dillon, SC 29536-1950 | 2006-10-18 |
| 1619058591 | Welvista | Dentist | 16 Weinberg St, Manning, SC 29102-2629 | 2006-10-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | WELVISTA, INC. | 2700 Middleburg Dr, Ste 108, Columbia, SC 29204 |
| Street Address |
3269 ALLENDALE FAIRFAX HWY |
| City | FAIRFAX |
| State | SC |
| Zip Code | 29827-9163 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104911346 | John Terry Poole IIi | Dentist | 3269 Allendale Fairfax Hwy, Fairfax, SC 29827-9163 | 2006-10-04 |
| 1609144997 | Jenni Marie O'malley Sherban | Dentist | 3269 Allendale Fairfax Hwy, Fairfax, SC 29827-9163 | 2011-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467843078 | We Care Family Resource LLC | Point of Service | 513 Bayshore Dr., Fairfax, SC 29827 | 2015-02-18 |
| 1154606440 | Robert M. Haberkorn Dds | Clinic/Center | 1987 Allendale Fairfax Hwy., Fairfax, SC 29827 | 2011-10-18 |
| 1144370503 | Allendale County Hospital Board | Clinic/Center | 1787 Allendale Fairfax Highway, Fairfax, SC 29827 | 2007-01-10 |
| 1336246677 | Allendale County Hospital Board | Skilled Nursing Facility | 185 Revolutionary Trail, Fairfax, SC 29827 | 2006-09-20 |
| 1881646669 | Shenika L. Marshall-hill | Counselor | 1594 Beaufort Ave. S., Fairfax, SC 29827 | 2006-05-17 |
| 1588623540 | Rebecca Lynn Wilkes | Nurse Practitioner | 333 Revolutionary Trail, Fairfax, SC 29827 | 2006-03-20 |
| 1497745012 | Robert M Haberkorn | Dentist | 1987 Allendale-fairfax Hwy, Fairfax, SC 29827 | 2005-10-25 |
| 1588815021 | James Robert Mynatt | Nurse Practitioner | 333 Revolutionary Trail, Fairfax, SC 29827 | 2008-10-02 |
| 1063607646 | Mol Ky | General Practice | 333 Revolutionary Trail, Fairfax, SC 29827 | 2007-09-07 |
| 1053475566 | Low Country Health Care System, Inc | Pharmacy | 333 Revolutionary Trail, Farifax, SC 29827 | 2006-12-20 |
| Find all providers in zip 29827 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952910358 | Erica Vetter | Dentist | 10525 Braddock Rd Ste 9a, Fairfax, VA 22032-2257 | 2020-07-31 |
| 1902414105 | Su Jung Kang | Dentist | 9661-c Main Street, Fairfax, VA 22031 | 2020-07-14 |
| 1194367623 | Ruhee Jaffer | Dentist | 11213 Lee Hwy Ste A, Fairfax, VA 22030-5698 | 2019-10-16 |
| 1093367310 | Gina Genevia Askander | Dentist | 2810 Old Lee Hwy Ste 200a, Fairfax, VA 22031-4376 | 2019-07-16 |
| 1609436989 | Hanwool Kim | Dentist | 8303 Arlington Blvd Ste 104, Fairfax, VA 22031-2903 | 2019-06-18 |
| 1942776182 | Sapphire Dental Pllc | Dentist | 8622 Lee Hwy, Fairfax, VA 22031-2173 | 2018-10-15 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1710496294 | Fairfax Dentistry, Pllc | Dentist | 11351 Random Hills Rd Ste 102, Fairfax, VA 22030-6081 | 2017-09-27 |
| 1558886580 | Marc Dh Eun | Dentist | 4511 Plateau Dr, Fairfax, VA 22030-6281 | 2017-08-10 |
| 1639603459 | Kouros Hedayati, Dds, Plc | Dentist | 3545 Chain Bridge Rd Ste 5, Fairfax, VA 22030-2708 | 2017-04-18 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.