Provider Demographics
NPI:1972733624
Name:BETHEA, ROBERT P (DDS,MSD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:BETHEA
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:P
Other - Last Name:BETHEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,MSD
Mailing Address - Street 1:34 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-3214
Mailing Address - Country:US
Mailing Address - Phone:803-787-0861
Mailing Address - Fax:803-787-0861
Practice Address - Street 1:34 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-3214
Practice Address - Country:US
Practice Address - Phone:803-787-0861
Practice Address - Fax:803-787-0861
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics