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Organization
SMILE CENTER OF KNIGHTSVILLE
Active
Organization
SMILE CENTER OF KNIGHTSVILLE
Active
Other names
Smile Center of Knightsville
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANINE ALICIA GOURDINE D.M.D. (OWNER/DENTIST)
(843) 261-0123
Entity
Organization
Contact information
Practice address
100 OMALLEY DR, SUITE B, SUMMERVILLE, SC 29483-5635
(843) 261-0123
(843) 261-0125
Mailing address
100 OMALLEY DR, SUITE B, SUMMERVILLE, SC 29483-5635
(843) 261-0123
(843) 261-0125
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4061
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX4061
—
SC
Enumeration date
12/04/2007
Last updated
12/04/2007
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