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General NPI Number Information
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NPI Number | 1831685536
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Entity Type | Individual
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Provider Name | ROBERT TANNER OLDHAM DMD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 09/25/2022
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Provider Practice Location Address
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Address Line | 272 CEDAR SPRINGS RD
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City | SPARTANBURG
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State | SC
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Zip | 29302-4643
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Country | US
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Telephone | 864-583-4962
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Fax | 864-583-6333
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Provider Business Mailing Address
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Address Line | 110 VILLA RD
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City | GREENVILLE
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State | SC
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Zip | 29615-3010
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Country | US
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Telephone | 864-282-1935
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Fax | 864-751-6387
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9181
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License Number State | SC
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