Healthcare Provider Details

I. General information

NPI: 1053573436
Provider Name (Legal Business Name): JAMI STUDER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL MEDICAL DR
GREENVILLE SC
29605-4407
US

IV. Provider business mailing address

1 MEMORIAL MEDICAL DR
GREENVILLE SC
29605-4407
US

V. Phone/Fax

Practice location:
  • Phone: 865-351-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number4680
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number150669
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: