Provider Demographics
NPI:1629080171
Name:RED, DENNIS J (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:RED
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 YEAMANS HALL RD
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-2750
Mailing Address - Country:US
Mailing Address - Phone:843-554-4545
Mailing Address - Fax:
Practice Address - Street 1:1224 YEAMANS HALL RD
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-2750
Practice Address - Country:US
Practice Address - Phone:843-554-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022403L1223G0001X
SC96711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice