Provider Demographics
NPI:1225519564
Name:MARENTETTE, DAWN MARIE (LDO)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:MARENTETTE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4638
Mailing Address - Country:US
Mailing Address - Phone:843-245-1233
Mailing Address - Fax:
Practice Address - Street 1:367 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3429
Practice Address - Country:US
Practice Address - Phone:843-665-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1001156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician