Provider Demographics
NPI:1235345331
Name:BRACEY, RONALD KENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KENT
Last Name:BRACEY
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 1:810 N 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2754
Mailing Address - Country:US
Mailing Address - Phone:843-841-9383
Mailing Address - Fax:843-774-7920
Practice Address - Street 1:101 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2421
Practice Address - Country:US
Practice Address - Phone:843-774-7662
Practice Address - Fax:843-774-7920
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899016XMedicaid
SCZX3765Medicaid