Provider Demographics
NPI:1316942766
Name:MARSH, SAMUEL JESSE (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JESSE
Last Name:MARSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2302 BUSH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5649
Mailing Address - Country:US
Mailing Address - Phone:803-798-8675
Mailing Address - Fax:803-798-4753
Practice Address - Street 1:2302 BUSH RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5649
Practice Address - Country:US
Practice Address - Phone:803-798-8675
Practice Address - Fax:803-798-4753
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry