Individual
DR. C FRED MARCINAK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
102 LUSK DR, WEST UNION, SC 29696-2629
(864) 638-7733
Mailing address
240 WINDRUSH TRL, WALHALLA, SC 29691-4623
(864) 638-7228
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2195
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002195
—
SC
Enumeration date
03/25/2007
Last updated
07/08/2007
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