Individual
MAE E JESNECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, LCSW
Contact information
Practice address
737 S MAIN ST, SOCIETY HILL, SC 29593-8972
(843) 378-3000
(843) 378-9869
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 857-0111
(843) 857-0206
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8667
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8667
—
SC
Enumeration date
01/05/2006
Last updated
09/13/2017
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