Individual
DR. THOMAS R JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
7535 NORTHSIDE DR, N CHARLESTON, SC 29420-4211
(843) 797-3355
(843) 797-3641
Mailing address
7535 NORTHSIDE DR, N CHARLESTON, SC 29420-4211
(843) 797-3355
(843) 797-3641
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
SC1851
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
805444
UNITED CONCORDIA
—
Enumeration date
08/25/2006
Last updated
07/08/2007
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