Individual
DR. MARK ANTHONY CHISHOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
102 BUCKTHORN CIR, ELGIN, SC 29045-8695
(803) 477-4909
Mailing address
102 BUCKTHORN CIR, ELGIN, SC 29045-8695
(803) 477-4909
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN014013
GA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
3253
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117364
UNITED CONCORDIA
—
05
—
ZX3253
—
SC
Enumeration date
05/15/2006
Last updated
04/02/2015
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