Provider Demographics
NPI:1285679530
Name:DENT, JOHN MARSHALL III (MD OBGYN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARSHALL
Last Name:DENT
Suffix:III
Gender:M
Credentials:MD OBGYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SOUTH COIT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501
Mailing Address - Country:US
Mailing Address - Phone:843-665-5055
Mailing Address - Fax:843-667-1954
Practice Address - Street 1:410 SOUTH COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-665-5055
Practice Address - Fax:843-667-1954
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13546207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3067Medicaid
SCGP3067Medicaid