Provider Demographics
NPI:1982622585
Name:DUNLAP, DEREK T (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:T
Last Name:DUNLAP
Suffix:
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 1:700 SQUIRE'S POINTE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334
Mailing Address - Country:US
Mailing Address - Phone:864-486-8330
Mailing Address - Fax:864-486-8358
Practice Address - Street 1:700 SQUIRE'S POINTE DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334
Practice Address - Country:US
Practice Address - Phone:864-486-8330
Practice Address - Fax:864-486-8358
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0035501223P0106X
SC3550204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3550Medicaid