Healthcare Provider Details

I. General information

NPI: 1104058098
Provider Name (Legal Business Name): TERI KORN HURST RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W WESMARK BLVD
SUMTER SC
29150-1977
US

IV. Provider business mailing address

360 W WESMARK BLVD
SUMTER SC
29150-1977
US

V. Phone/Fax

Practice location:
  • Phone: 803-469-2061
  • Fax: 803-469-2073
Mailing address:
  • Phone: 803-469-2061
  • Fax: 803-469-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3872
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: