Healthcare Provider Details

I. General information

NPI: 1558480764
Provider Name (Legal Business Name): DR. SANDRA REID BIGELOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH SANDRA REID DMD

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PINCKNEY ST.
MCCLELLANVILLE SC
29458
US

IV. Provider business mailing address

PO BOX 9
MC CLELLANVILLE SC
29458-0009
US

V. Phone/Fax

Practice location:
  • Phone: 843-887-3763
  • Fax: 843-887-4228
Mailing address:
  • Phone: 843-887-3763
  • Fax: 843-887-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2205
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: