Provider Demographics
NPI:1407530405
Name:MEDLIN, KACEY LAUREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KACEY
Middle Name:LAUREN
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N LIBERTY ST APT C119
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1116
Mailing Address - Country:US
Mailing Address - Phone:843-260-0276
Mailing Address - Fax:
Practice Address - Street 1:1242 PARKSIDE ACORN DRIVE
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-8344
Practice Address - Country:US
Practice Address - Phone:864-578-9366
Practice Address - Fax:844-222-4531
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.10529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist