Provider Demographics
NPI:1043462047
Name:ROBERT E DEANE, DMD, MS,PA
Entity type:Organization
Organization Name:ROBERT E DEANE, DMD, MS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-546-4416
Mailing Address - Street 1:301 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2405
Mailing Address - Country:US
Mailing Address - Phone:843-546-4416
Mailing Address - Fax:
Practice Address - Street 1:301 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2405
Practice Address - Country:US
Practice Address - Phone:843-546-4416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty