Provider Demographics
NPI:1811975923
Name:DANTZLER, TODD ELLIS (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ELLIS
Last Name:DANTZLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 SEIGNIOUS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-8232
Mailing Address - Country:US
Mailing Address - Phone:843-377-7008
Mailing Address - Fax:
Practice Address - Street 1:25 COURTENAY DR # 7100A
Practice Address - Street 2:MSC 290
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-2900
Practice Address - Country:US
Practice Address - Phone:843-876-4261
Practice Address - Fax:843-876-7232
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29638207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology