Individual
JEFFREY CRAIG GOURDINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1422 BELLS HWY, WALTERBORO, SC 29488-2516
(843) 538-7330
(843) 538-7336
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 857-0111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4022
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX4022
—
SC
Enumeration date
04/26/2006
Last updated
09/13/2017
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