Healthcare Provider Details

I. General information

NPI: 1518986496
Provider Name (Legal Business Name): JENNIFER L GARVEY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 REGENT PARK CT
GREENVILLE SC
29607-6534
US

IV. Provider business mailing address

100 REGENT PARK CT
GREENVILLE SC
29607-6534
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-3424
  • Fax: 864-234-8234
Mailing address:
  • Phone: 864-234-3424
  • Fax: 864-234-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3638
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: