Provider Demographics
NPI:1467438846
Name:GUTKNECHT SAMS, TERRY ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ANNE
Last Name:GUTKNECHT SAMS
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 1:103 E TATUM AVE
Mailing Address - Street 2:
Mailing Address - City:MC COLL
Mailing Address - State:SC
Mailing Address - Zip Code:29570-2323
Mailing Address - Country:US
Mailing Address - Phone:843-523-5291
Mailing Address - Fax:843-523-9714
Practice Address - Street 1:103 E TATUM AVE
Practice Address - Street 2:PALMETTO DENTAL HEALTH ASSOCIATES
Practice Address - City:MC COLL
Practice Address - State:SC
Practice Address - Zip Code:29570-2323
Practice Address - Country:US
Practice Address - Phone:843-523-5291
Practice Address - Fax:843-523-9714
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC4152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4152Medicaid