Provider Demographics
NPI:1730296690
Name:SMOAK, DAHLMON L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAHLMON
Middle Name:L
Last Name:SMOAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2145 HENRY TECKLENBURG DR
Practice Address - Street 2:SUITE 270
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5893
Practice Address - Country:US
Practice Address - Phone:843-577-0220
Practice Address - Fax:843-577-4193
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC5727207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00648642OtherRAILROAD MEDICARE ID
SCP00811378OtherRAILROAD MEDICARE ID-RSFPN
SC057272Medicaid
SCD99101Medicare UPIN
SCD991015551Medicare PIN
SCP00648642OtherRAILROAD MEDICARE ID