Provider Demographics
NPI:1730602202
Name:ABERCROMBIE, AMELIA BAXLEY (DMD)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:BAXLEY
Last Name:ABERCROMBIE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:SIKES
Other - Last Name:BAXLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:752 MATTISON AVE
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-3108
Mailing Address - Country:US
Mailing Address - Phone:803-528-9092
Mailing Address - Fax:
Practice Address - Street 1:669 W MARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1900
Practice Address - Country:US
Practice Address - Phone:803-905-3567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9847122300000X
NC10788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist