Provider Demographics
NPI:1902801400
Name:DEDMON, DAVID BRYON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRYON
Last Name:DEDMON
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 1:364 S PINE ST
Mailing Address - Street 2:STE A101
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2654
Mailing Address - Country:US
Mailing Address - Phone:864-582-5000
Mailing Address - Fax:864-582-3756
Practice Address - Street 1:364 S PINE ST
Practice Address - Street 2:STE A101
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2654
Practice Address - Country:US
Practice Address - Phone:864-582-5000
Practice Address - Fax:864-582-3756
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice