Individual
DR. SUSAN H JAQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
303 BURCH FORD RD, HOLLY HILL, SC 29059
(803) 496-9012
(803) 496-7054
Mailing address
303 BURCH FORD RD, HOLLY HILL, SC 29059
(803) 496-9012
(803) 496-7054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2538
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
992538
—
SC
Enumeration date
08/16/2006
Last updated
07/08/2007
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