Provider Demographics
NPI:1376564864
Name:MCPHERSON, DOUGLAS WAYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:MCPHERSON
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:BLDG. 4323, HILL STREET
Mailing Address - Street 2:
Mailing Address - City:FT. JACKSON
Mailing Address - State:SC
Mailing Address - Zip Code:29207
Mailing Address - Country:US
Mailing Address - Phone:803-751-1685
Mailing Address - Fax:803-751-4427
Practice Address - Street 1:BLDG. 4323, HILL STREET
Practice Address - Street 2:
Practice Address - City:FT. JACKSON
Practice Address - State:SC
Practice Address - Zip Code:29207
Practice Address - Country:US
Practice Address - Phone:803-751-1685
Practice Address - Fax:803-751-4427
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30-22851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice