Healthcare Provider Details

I. General information

NPI: 1720228927
Provider Name (Legal Business Name): JING ZHOU DDS, PH.D, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 MAYBANK HWY STE B
JOHNS ISLAND SC
29455-4821
US

IV. Provider business mailing address

1493 APPLING DR
MOUNT PLEASANT SC
29464-4688
US

V. Phone/Fax

Practice location:
  • Phone: 843-800-2505
  • Fax: 843-868-8754
Mailing address:
  • Phone: 317-260-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8490
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: