Provider Demographics
NPI:1083827620
Name:J. MARK LAWHON, DMD, PA
Entity Type:Organization
Organization Name:J. MARK LAWHON, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LAWHON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-669-7044
Mailing Address - Street 1:230 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5225
Mailing Address - Country:US
Mailing Address - Phone:843-669-7044
Mailing Address - Fax:843-669-7052
Practice Address - Street 1:230 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5225
Practice Address - Country:US
Practice Address - Phone:843-669-7044
Practice Address - Fax:843-669-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9720Medicaid
SCZA9720Medicaid
SCU823320281Medicare UPIN