Provider Demographics
NPI:1417047499
Name:CAGLE, JOHN NEWTON III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NEWTON
Last Name:CAGLE
Suffix:III
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 1:902 COLEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4046
Mailing Address - Country:US
Mailing Address - Phone:843-884-4340
Mailing Address - Fax:843-884-1703
Practice Address - Street 1:902 COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4046
Practice Address - Country:US
Practice Address - Phone:843-884-4340
Practice Address - Fax:843-884-1703
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZZ2564Medicaid