Healthcare Provider Details

I. General information

NPI: 1154457844
Provider Name (Legal Business Name): RONALD GREGG JOWERS JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HAMPTON ST
COLUMBIA SC
29204-1002
US

IV. Provider business mailing address

2000 HAMPTON ST
COLUMBIA SC
29204-1002
US

V. Phone/Fax

Practice location:
  • Phone: 803-576-2739
  • Fax: 803-576-2995
Mailing address:
  • Phone: 803-576-2739
  • Fax: 803-576-2995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number04085
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: