MEDICARE: JACOB TANNER PLOWMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11445	SC

General Provider Information

NPI Number	:	1144163270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB TANNER PLOWMAN

Provider Business Mailing Address
First Line	:	1300 FAIRMOUNT AVE UNIT 1443
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-2494
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7398 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4613
Country	:	US
Telephone Number	:	843-405-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	06/09/2026

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