MEDICARE: DR. JIMMY A. DUENSING D.M.D.

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	122300000X	Dentist	2259	SC

General Provider Information

NPI Number	:	1194983767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMY A. DUENSING D.M.D.

Provider Business Mailing Address
First Line	:	8012 SUMTER HWY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-5116
Country	:	US
Telephone Number	:	803-783-0694
Fax Number	:

Provider Business Practice Location Address
First Line	:	8012 SUMTER HWY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-5116
Country	:	US
Telephone Number	:	803-783-0694
Fax Number	:

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

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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