Healthcare Provider Details

I. General information

NPI: 1023953494
Provider Name (Legal Business Name): JEAN BRUCE RDH, OMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 LIMERICK RD
MYRTLE BEACH SC
29579-7038
US

IV. Provider business mailing address

3880 LIMERICK RD
MYRTLE BEACH SC
29579-7038
US

V. Phone/Fax

Practice location:
  • Phone: 843-907-0648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3490
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: