Provider Demographics
NPI:1770538209
Name:RHENEY, JOHN W III (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:RHENEY
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 1:882 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2126
Mailing Address - Country:US
Mailing Address - Phone:803-536-9503
Mailing Address - Fax:803-536-9714
Practice Address - Street 1:882 COOK ROAD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2126
Practice Address - Country:US
Practice Address - Phone:803-536-9503
Practice Address - Fax:803-536-9714
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC450005Medicaid