Provider Demographics
NPI:1790979680
Name:NEVILLE, RUFUS LESTER III (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUFUS
Middle Name:LESTER
Last Name:NEVILLE
Suffix:III
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:PO BOX 2324
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-2324
Mailing Address - Country:US
Mailing Address - Phone:843-323-1959
Mailing Address - Fax:
Practice Address - Street 1:1051 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3100
Practice Address - Country:US
Practice Address - Phone:843-388-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice