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General NPI Number Information
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NPI Number | 1316942766
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Entity Type | Individual
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Provider Name | SAMUEL JESSE MARSH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2302 BUSH RIVER RD
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City | COLUMBIA
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State | SC
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Zip | 29210-5649
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Country | US
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Telephone | 803-798-8675
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Fax | 803-798-4753
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Provider Business Mailing Address
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Address Line | 2302 BUSH RIVER RD
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City | COLUMBIA
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State | SC
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Zip | 29210-5649
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Country | US
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Telephone | 803-798-8675
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Fax | 803-798-4753
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1192
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License Number State | SC
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