Provider Demographics
NPI:1558480764
Name:BIGELOW, SANDRA REID
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:REID
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:SANDRA
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29458-0009
Mailing Address - Country:US
Mailing Address - Phone:843-887-3763
Mailing Address - Fax:843-887-4228
Practice Address - Street 1:832 PINCKNEY ST.
Practice Address - Street 2:
Practice Address - City:MCCLELLANVILLE
Practice Address - State:SC
Practice Address - Zip Code:29458
Practice Address - Country:US
Practice Address - Phone:843-887-3763
Practice Address - Fax:843-887-4228
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ22057Medicaid