Provider Demographics
NPI:1174678783
Name:CHEWNING & MCDONALD ORAL & MAXIL PA
Entity Type:Organization
Organization Name:CHEWNING & MCDONALD ORAL & MAXIL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MD
Authorized Official - Phone:843-667-6000
Mailing Address - Street 1:901 E CHEVES STREET
Mailing Address - Street 2:STE 440
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2772
Mailing Address - Country:US
Mailing Address - Phone:843-667-6000
Mailing Address - Fax:843-667-6240
Practice Address - Street 1:901 E CHEVES STREET
Practice Address - Street 2:STE 440
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2772
Practice Address - Country:US
Practice Address - Phone:843-667-6000
Practice Address - Fax:843-667-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9867Medicaid
SC5888Medicare PIN
SCT24211Medicare UPIN
SCZA9867Medicaid