Provider Demographics
NPI:1568963593
Name:HAIR, BRANDI ROLLINS (DMD)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:ROLLINS
Last Name:HAIR
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:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1090
Mailing Address - Country:US
Mailing Address - Phone:843-378-4501
Mailing Address - Fax:
Practice Address - Street 1:737 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SOCIETY HILL
Practice Address - State:SC
Practice Address - Zip Code:29593-8972
Practice Address - Country:US
Practice Address - Phone:843-857-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC93021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program