Provider Demographics
NPI:1073769600
Name:SPACEY, EUGENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:SPACEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4817
Mailing Address - Country:US
Mailing Address - Phone:843-559-3135
Mailing Address - Fax:843-559-3137
Practice Address - Street 1:3201 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4817
Practice Address - Country:US
Practice Address - Phone:843-559-3135
Practice Address - Fax:843-559-3137
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ29586Medicaid