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1987 Allendale Fairfax Hwy. Fairfax SC 29827 | |
| (803) 632-3301 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1987 Allendale Fairfax Hwy., Fairfax, South Carolina |
| Authorized Official Name and Position | Robert M Haberkorn (OWNER) |
| Authorized Official Contact | 8036323301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
P.o. Box 368 Fairfax SC 29827 Ph: (803) 632-3301 | 1987 Allendale Fairfax Hwy. Fairfax SC 29827 Ph: (803) 632-3301 |
| NPI Number | 1154606440 |
|---|---|
| Provider Enumeration Date | 10/18/2011 |
| Last Update Date | 12/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154606440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 6951 (South Carolina) | Primary |
Spencer B Wagner Dmd Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1987 Allendale Fairfax Hwy, Fairfax, SC 29827 Phone: 803-632-3301 Fax: 803-632-1240 |