MEDICARE: FAMILY DENTISTRY JARED P. TAVERNIER DMD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8591	SC

General Provider Information

NPI Number	:	1477936458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DENTISTRY JARED P. TAVERNIER DMD, PA

Provider Business Mailing Address
First Line	:	321 N CAMBRIDGE ST
Second Line	:
City	:	NINETY SIX
State	:	SC
Zip	:	29666-1012
Country	:	US
Telephone Number	:	864-543-4109
Fax Number	:	864-543-3246

Provider Business Practice Location Address
First Line	:	321 N CAMBRIDGE ST
Second Line	:
City	:	NINETY SIX
State	:	SC
Zip	:	29666-1012
Country	:	US
Telephone Number	:	864-543-4109
Fax Number	:	864-543-3246

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	DR. JARED PRESTON TAVERNIER
Credential	:	D.M.D.
Telephone Number	:	864-934-3637

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	07/08/2015

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