MEDICARE: DR. RONALD BRENT CALCUTT JR. D.M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3875	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255384038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD BRENT CALCUTT JR. D.M.D., P.A.

Provider Business Mailing Address
First Line	:	508 WALKINGSTICK WAY
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-7216
Country	:	US
Telephone Number	:	864-228-7297
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 N MAIN ST
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-1611
Country	:	US
Telephone Number	:	864-862-2966
Fax Number	:	864-862-2112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/09/2007

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