Provider Demographics
NPI:1881731644
Name:J. MARSHALL DENT,III,M.D.,P.C.
Entity type:Organization
Organization Name:J. MARSHALL DENT,III,M.D.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D.,OBGYN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:DENT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD,OBGYN
Authorized Official - Phone:843-665-5055
Mailing Address - Street 1:410 S COIT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4715
Mailing Address - Country:US
Mailing Address - Phone:843-665-5055
Mailing Address - Fax:843-667-1954
Practice Address - Street 1:410 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4715
Practice Address - Country:US
Practice Address - Phone:843-665-5055
Practice Address - Fax:843-667-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13546207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3067Medicaid
SC135464Medicaid