1619139482 NPI number — DR. SHERRY BENENHALEY RAUCH DDS

Table of content: DR. SHERRY BENENHALEY RAUCH DDS (NPI 1619139482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619139482 NPI number — DR. SHERRY BENENHALEY RAUCH DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAUCH
Provider First Name:
SHERRY
Provider Middle Name:
BENENHALEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619139482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
671 TWIN PINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPIN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29036-8025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-414-3886
Provider Business Mailing Address Fax Number:
803-749-3335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7436 BROAD RIVER RD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
IRMO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29063-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-749-3333
Provider Business Practice Location Address Fax Number:
803-749-3335
Provider Enumeration Date:
07/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4654 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZX4654 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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