Healthcare Provider Details

I. General information

NPI: 1548399793
Provider Name (Legal Business Name): WILLIAM H. FOURNIER JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 SAINT ANDREWS BLVD
CHARLESTON SC
29407-7343
US

IV. Provider business mailing address

1282 S BARKSDALE RD
MT PLEASANT SC
29464-5100
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-5858
  • Fax: 843-766-5818
Mailing address:
  • Phone: 843-884-2211
  • Fax: 843-766-5818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1624
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: