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General NPI Number Information
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NPI Number | 1043462047
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Entity Type | Organization
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Legal Business Name | ROBERT E DEANE, DMD, MS,PA
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 301 CHURCH ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-2405
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Country | US
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Telephone | 843-546-4416
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Fax |
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Provider Business Mailing Address
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Address Line | 301 CHURCH ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-2405
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Country | US
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Telephone | 843-546-4416
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT EDWIN DEANE
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Credential | DMD
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Telephone | 843-546-4416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2634
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License Number State | SC
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