Provider Demographics
NPI:1205918174
Name:LETHCO, ANDREW KEITH (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KEITH
Last Name:LETHCO
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 1:1815 MONTAGUE AVE EXT
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649
Mailing Address - Country:US
Mailing Address - Phone:864-223-2433
Mailing Address - Fax:864-223-3896
Practice Address - Street 1:1815 MONTAGUE AVE EXT
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-223-2433
Practice Address - Fax:864-223-3896
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZZ2737Medicaid