Healthcare Provider Details

I. General information

NPI: 1730395856
Provider Name (Legal Business Name): JOYCE HAWKINS RIVERS RDH,BHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GREEN OAKS RD
GREENWOOD SC
29649
US

IV. Provider business mailing address

100 OLD CHEROKEE RD SUITE F, PMB 14
LEXINGTON SC
29072-9316
US

V. Phone/Fax

Practice location:
  • Phone: 864-229-1171
  • Fax: 864-223-0098
Mailing address:
  • Phone: 803-808-2950
  • Fax: 803-808-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1064
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: