Provider Demographics
NPI:1437607413
Name:WASHINGTON, KENT TANNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:TANNER
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MALLET HILL RD
Mailing Address - Street 2:APT D1
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5726
Mailing Address - Country:US
Mailing Address - Phone:803-699-9989
Mailing Address - Fax:803-699-8035
Practice Address - Street 1:625 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-8190
Practice Address - Country:US
Practice Address - Phone:803-699-9989
Practice Address - Fax:803-699-8035
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics