Provider Demographics
NPI:1740407741
Name:MCENIRY, MICHAEL CHRISTOPHER SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:MCENIRY
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 N JEFFERIES BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2729
Mailing Address - Country:US
Mailing Address - Phone:843-549-5584
Mailing Address - Fax:843-549-2011
Practice Address - Street 1:1133 N JEFFERIES BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2729
Practice Address - Country:US
Practice Address - Phone:843-549-5584
Practice Address - Fax:843-549-2011
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist