Healthcare Provider Details

I. General information

NPI: 1457293458
Provider Name (Legal Business Name): JEREMIAH RAEMAN JUAREZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCRD PARRIS ISLAND DENTAL BLDG 674 BLVD DE FRANCE
PARRIS ISLAND SC
29905
US

IV. Provider business mailing address

674 BOULEVARD DE FRANCE
PARRIS ISLAND SC
29905
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11397
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: