Provider Demographics
NPI:1548412968
Name:CHERAW FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CHERAW FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROACHEL
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-537-9044
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:3137 HWY 9 W
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520
Mailing Address - Country:US
Mailing Address - Phone:843-537-9044
Mailing Address - Fax:843-537-5853
Practice Address - Street 1:3137 HWY 9 W
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520
Practice Address - Country:US
Practice Address - Phone:843-537-9044
Practice Address - Fax:843-537-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4509122300000X
SC16421223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX1642Medicaid