Gourdine, Jeanine Alicia
Gourdine, Jeanine Alicia is an sole proprietor health care provider with primary practice located at 100 Omalley Dr Suite B, Summerville SC 29483-5635. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Gourdine, Jeanine Alicia can be contacted via phone (843) 261-0123.Contact Information
Primary practice address
100 Omalley Dr Suite B
Summerville SC 29483-5635
Phone: (843) 261-0123
Fax: (843) 261-0125
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 4061 | South Carolina |
Profile Details
| NPI number | 1427014786 |
|---|---|
| LBN Legal business name | Gourdine, Jeanine Alicia |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 25th, 2006 |
| Last updated | Sep 13th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427014786 | NPPES |
| South Carolina | MEDICAID | ZX4061 |
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