Provider Demographics
NPI:1801914122
Name:DR GWYN GORDON MCCUTCHEN INC
Entity type:Organization
Organization Name:DR GWYN GORDON MCCUTCHEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWYN
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MCCUTCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-756-5747
Mailing Address - Street 1:POST OFFICE BOX 220
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569
Mailing Address - Country:US
Mailing Address - Phone:843-756-5747
Mailing Address - Fax:843-756-5749
Practice Address - Street 1:3681 SPIVEY STREET
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569
Practice Address - Country:US
Practice Address - Phone:843-756-5747
Practice Address - Fax:843-756-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty