Provider Demographics
NPI:1003104746
Name:ONDERSMA, MARGARET BRUNSON (DMD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:BRUNSON
Last Name:ONDERSMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BOYCE LAWTON DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:SC
Mailing Address - Zip Code:29030-9561
Mailing Address - Country:US
Mailing Address - Phone:803-823-2100
Mailing Address - Fax:803-823-2112
Practice Address - Street 1:114 BOYCE LAWTON DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:SC
Practice Address - Zip Code:29030-9561
Practice Address - Country:US
Practice Address - Phone:803-823-2100
Practice Address - Fax:803-823-2112
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC70491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice