Provider Demographics
NPI:1376546374
Name:DENNIS, MCGREGOR T JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MCGREGOR
Middle Name:T
Last Name:DENNIS
Suffix:JR
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 1:219 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-2692
Mailing Address - Country:US
Mailing Address - Phone:843-761-7121
Mailing Address - Fax:843-761-7121
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-2692
Practice Address - Country:US
Practice Address - Phone:843-761-7121
Practice Address - Fax:843-761-7121
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ31038Medicaid