Provider Demographics
NPI:1710005574
Name:MARLA T MCMAHON DMD LLC
Entity Type:Organization
Organization Name:MARLA T MCMAHON DMD LLC
Other - Org Name:MARLA T MCMAHON SIMMONS
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL DENTIST PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-723-5405
Mailing Address - Street 1:198 RUTLEDGE AVE
Mailing Address - Street 2:#3
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5817
Mailing Address - Country:US
Mailing Address - Phone:843-723-5405
Mailing Address - Fax:
Practice Address - Street 1:198 RUTLEDGE AVE
Practice Address - Street 2:#3
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5817
Practice Address - Country:US
Practice Address - Phone:843-723-5405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty