Provider Demographics
NPI:1821047739
Name:MARKS, RICHARD S (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:MARKS
Suffix:
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 1:5 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1927
Mailing Address - Country:US
Mailing Address - Phone:803-469-2044
Mailing Address - Fax:803-469-2148
Practice Address - Street 1:5 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1927
Practice Address - Country:US
Practice Address - Phone:803-469-2044
Practice Address - Fax:803-469-2148
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ21968Medicaid
SCT244010281Medicare ID - Type Unspecified
SCT24401Medicare UPIN