Chishom, Mark Anthony

Chishom, Mark Anthony is an individual health care provider with primary practice located at 102 Buckthorn Cir , Elgin SC 29045-8695. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery, Dental Providers / Oral and Maxillofacial Surgery. Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery is his primary health care specialty. Chishom, Mark Anthony can be contacted via phone (803) 477-4909.

Contact Information

Primary practice address
102 Buckthorn Cir Elgin SC 29045-8695
Phone: (803) 477-4909
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 3253 South Carolina
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X DN014013 Georgia

Profile Details

NPI number 1417908328
LBN Legal business name Chishom, Mark Anthony
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 15th, 2006
Last updated Apr 2nd, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417908328 NPPES
Other 117364 UNITED CONCORDIA
MEDICAID ZX3253 UNITED CONCORDIA

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