Provider Demographics
NPI:1508041419
Name:FENNELL, JOSEPH D JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:FENNELL
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOSH
Other - Middle Name:D
Other - Last Name:FENNELL
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3404 COKESBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:HODGES
Mailing Address - State:SC
Mailing Address - Zip Code:29653
Mailing Address - Country:US
Mailing Address - Phone:864-227-6911
Mailing Address - Fax:864-227-8678
Practice Address - Street 1:3404 COKESBURY ROAD
Practice Address - Street 2:
Practice Address - City:HODGES
Practice Address - State:SC
Practice Address - Zip Code:29653
Practice Address - Country:US
Practice Address - Phone:864-227-6911
Practice Address - Fax:864-227-8678
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist