Healthcare Provider Details

I. General information

NPI: 1720045776
Provider Name (Legal Business Name): JEFFREY CRAIG GOURDINE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PAIGE POINT RD
SEABROOK SC
29940-2737
US

IV. Provider business mailing address

721 OKATIE HWY
OKATIE SC
29909-3963
US

V. Phone/Fax

Practice location:
  • Phone: 843-846-8148
  • Fax:
Mailing address:
  • Phone: 843-987-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4022
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: