Provider Demographics
NPI:1477936458
Name:FAMILY DENTISTRY JARED P. TAVERNIER DMD, PA
Entity Type:Organization
Organization Name:FAMILY DENTISTRY JARED P. TAVERNIER DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:TAVERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-934-3637
Mailing Address - Street 1:321 N CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NINETY SIX
Mailing Address - State:SC
Mailing Address - Zip Code:29666-1012
Mailing Address - Country:US
Mailing Address - Phone:864-543-4109
Mailing Address - Fax:864-543-3246
Practice Address - Street 1:321 N CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:NINETY SIX
Practice Address - State:SC
Practice Address - Zip Code:29666-1012
Practice Address - Country:US
Practice Address - Phone:864-543-4109
Practice Address - Fax:864-543-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty