MEDICARE: DR. FREDERICK MADISON GUNTER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0156	SC

General Provider Information

NPI Number	:	1003836776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK MADISON GUNTER DDS

Provider Business Mailing Address
First Line	:	7465 NORTHSIDE DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-4209
Country	:	US
Telephone Number	:	843-553-7300
Fax Number	:	843-797-7631

Provider Business Practice Location Address
First Line	:	7465 NORTHSIDE DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-4209
Country	:	US
Telephone Number	:	843-553-7300
Fax Number	:	843-797-7631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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