Healthcare Provider Details

I. General information

NPI: 1497608871
Provider Name (Legal Business Name): JEANNINE ANN JOHNSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 MEDICAL PLAZA DR
N CHARLESTON SC
29406-9125
US

IV. Provider business mailing address

9228 MEDICAL PLAZA DR
CHARLESTON SC
29406-9125
US

V. Phone/Fax

Practice location:
  • Phone: 843-574-5693
  • Fax: 843-764-4512
Mailing address:
  • Phone: 843-574-5693
  • Fax: 843-764-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2451
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: