Healthcare Provider Details

I. General information

NPI: 1326041237
Provider Name (Legal Business Name): JEANNE L. FOURRIER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 GLENNS BAY RD
SURFSIDE BEACH SC
29575-4833
US

IV. Provider business mailing address

1947 GLENNS BAY RD
SURFSIDE BEACH SC
29575-4833
US

V. Phone/Fax

Practice location:
  • Phone: 843-650-7171
  • Fax:
Mailing address:
  • Phone: 843-650-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2643
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: