C Fred Marcinak DMD PA

Primary specialty

DentistTaxonomy code 122300000X

License

2195 Issued in SC

Legal business name

C FRED MARCINAK DMD PA

Practice address

102 Lusk Drive
West Union, SC 29696

Phone

(864) 638-7228

Fax

(864) 718-7162

NPI assigned

Dec 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. C Fred Marcinak, DMD

Title

Dentist President

Phone

(864) 638-7228

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164583183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 648",
            "city": "WALHALLA",
            "state": "SC",
            "postal_code": "29691",
            "telephone_number": "864-638-7228",
            "fax_number": "864-718-7162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 LUSK DRIVE",
            "city": "WEST UNION",
            "state": "SC",
            "postal_code": "29696",
            "telephone_number": "864-638-7228",
            "fax_number": "864-718-7162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C FRED MARCINAK DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARCINAK",
        "authorized_official_first_name": "C",
        "authorized_official_middle_name": "FRED",
        "authorized_official_title_or_position": "DENTIST PRESIDENT",
        "authorized_official_telephone_number": "864-638-7228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "2195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002195",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in West Union, SC
• Providers in West Union, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.