Provider Demographics
NPI:1619253135
Name:PIERCE, DAPHNE R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:R
Last Name:PIERCE
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 1:1041 JOHNNIE DODDS BLVD STE 4A
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6156
Mailing Address - Country:US
Mailing Address - Phone:843-849-7609
Mailing Address - Fax:843-849-7612
Practice Address - Street 1:1041 JOHNNIE DODDS BLVD STE 4A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6156
Practice Address - Country:US
Practice Address - Phone:843-849-7609
Practice Address - Fax:843-849-7612
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice