Frederick Wayde Dominick, DMD
Individual provider Active NPI Dentist · Chapin, SC
NPI 1154400224 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154400224
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2637 (SC)
- Practice address
- 123 Amicks Ferry Road
Dr Frederick Wayde Dominick
Chapin, SC 29036 - Phone
- (803) 345-3599
- NPI assigned
- Nov 2, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2637 | SC | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2637 | SC | Yes |
Addresses
Primary practice location
123 Amicks Ferry Road
Dr Frederick Wayde Dominick
Chapin, SC 29036
Mailing address
123 Amicks Ferry Road
Chapin, SC 29036
Phone (803) 345-3599
Other providers in Chapin, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.