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Individual

DR. RICHARD T. PROVINE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.M.D

Contact information

Practice address
1111 W O EZELL BLVD, STE.A, SPARTANBURG, SC 29301-1655
(864) 576-0943
(864) 576-7989
Mailing address
108 AMBER DR, INMAN, SC 29349-9568
(864) 472-5708

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1821
SC

Other

Enumeration date
11/01/2006
Last updated
05/07/2008
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