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General NPI Number Information
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NPI Number | 1154869204
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Entity Type | Organization
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Legal Business Name | DEATON DENTAL LLC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 209 W 5TH NORTH ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6511
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Country | US
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Telephone | 843-873-3706
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Fax |
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Provider Business Mailing Address
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Address Line | 209 W 5TH NORTH STREET
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City | SUMMERVILLE
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State | SC
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Zip | 29483
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Country | US
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Telephone | 843-873-3706
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | STEVEN RHETT DEATON
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Credential |
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Telephone | 706-498-7330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8729
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License Number State | SC
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