Provider Demographics
NPI:1881732691
Name:TATE, ELZIE LEE III (DMD)
Entity type:Individual
Prefix:
First Name:ELZIE
Middle Name:LEE
Last Name:TATE
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 1:19309 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-9130
Mailing Address - Country:US
Mailing Address - Phone:864-457-4037
Mailing Address - Fax:864-599-7804
Practice Address - Street 1:8737 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29316-4609
Practice Address - Country:US
Practice Address - Phone:864-578-5812
Practice Address - Fax:864-599-7804
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice