Provider Demographics
NPI:1316021736
Name:MCVICKER, DONALD W (DMD PA)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:MCVICKER
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 GARDNER LANE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-766-5070
Mailing Address - Fax:843-763-7348
Practice Address - Street 1:1064 GARDNER LANE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-766-5070
Practice Address - Fax:843-763-7348
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics