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NPI Code Detail

MEDICARE: JOHN MICHAEL REARDEN D.M.D.

MEDICARE:   JOHN MICHAEL REARDEN  D.M.D.
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
1122300000XDentist3556SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871541896
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN MICHAEL REARDEN D.M.D.
Provider Business Mailing Address
First Line : 3012 NEWCASTLE LOOP
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588
Country : US
Telephone Number : 843-215-2599
Fax Number : 843-215-0238
Provider Business Practice Location Address
First Line : 3012 NEWCASTLE LOOP
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588
Country : US
Telephone Number : 843-215-2599
Fax Number : 843-215-0238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 07/08/2007

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Directions to “ JOHN MICHAEL REARDEN D.M.D.” Practice Location

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