Healthcare Provider Details

I. General information

NPI: 1750304176
Provider Name (Legal Business Name): ELIZABETH JANE BJORNSON DDS, MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 CHUCK DAWLEY BLVD SUITE 101
MT PLEASANT SC
29464-7304
US

IV. Provider business mailing address

1321 CHUCK DAWLEY BLVD SUITE 101
MT PLEASANT SC
29464-7304
US

V. Phone/Fax

Practice location:
  • Phone: 843-881-9909
  • Fax: 843-881-8481
Mailing address:
  • Phone: 843-881-9909
  • Fax: 843-881-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0352
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: