Provider Demographics
NPI:1780648576
Name:MCGINNIS, MICHAEL A (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 WILSON HALL RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1889
Mailing Address - Country:US
Mailing Address - Phone:803-905-4404
Mailing Address - Fax:803-905-4406
Practice Address - Street 1:1210 WILSON HALL RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1889
Practice Address - Country:US
Practice Address - Phone:803-905-4404
Practice Address - Fax:803-905-4406
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3273122300000X
SC4741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
872701OtherUNITED CONCORDIA
SCZ32732Medicaid
AL88003121OtherBLUE CROSS BLUE SHIELD
SCZ32732Medicaid