Individual
JEANINE ALICIA GOURDINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
100 OMALLEY DR, SUITE B, SUMMERVILLE, SC 29483-5635
(843) 261-0123
(843) 261-0125
Mailing address
PO BOX 1090, SUITE B, HARTSVILLE, SC 29551-1090
(843) 857-0111
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
04/25/2006
Last updated
09/13/2017
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