Healthcare Provider Details

I. General information

NPI: 1558385245
Provider Name (Legal Business Name): JERRY LEE AYERS JR. DMD, MHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 BUSH RIVER RD
COLUMBIA SC
29210-4805
US

IV. Provider business mailing address

3527 BUSH RIVER RD
COLUMBIA SC
29210-4805
US

V. Phone/Fax

Practice location:
  • Phone: 803-798-0894
  • Fax: 803-731-7887
Mailing address:
  • Phone: 803-798-0894
  • Fax: 803-731-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2616
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: