| Smile Center Of Knightsville | |
|
100 Omalley Dr Suite B Summerville SC 29483-5635 | |
| (843) 261-0123 | |
| (843) 261-0125 |
| Full Name | Smile Center Of Knightsville |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 100 Omalley Dr, Summerville, South Carolina |
| Authorized Official Name and Position | Jeanine Alicia Gourdine (OWNER/DENTIST) |
| Authorized Official Contact | 8432610123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smile Center Of Knightsville 100 Omalley Dr Suite B Summerville SC 29483-5635 Ph: (843) 261-0123 | Smile Center Of Knightsville 100 Omalley Dr Suite B Summerville SC 29483-5635 Ph: (843) 261-0123 |
| NPI Number | 1558543249 |
|---|---|
| Provider Enumeration Date | 12/04/2007 |
| Last Update Date | 12/04/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558543249 | NPI | - | NPPES |
| ZX4061 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4061 (South Carolina) | Primary |
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