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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