Provider Demographics
NPI:1407167711
Name:HEALEY, MICHAEL BRENDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRENDAN
Last Name:HEALEY
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 1:804 SAGE BIRD VW
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9465
Mailing Address - Country:US
Mailing Address - Phone:843-724-9923
Mailing Address - Fax:
Practice Address - Street 1:39 PRESBYTERIAN ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1950
Practice Address - Country:US
Practice Address - Phone:803-245-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice