Provider Demographics
NPI:1518986496
Name:GARVEY, JENNIFER L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:GARVEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 REGENT PARK CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6534
Mailing Address - Country:US
Mailing Address - Phone:864-234-3424
Mailing Address - Fax:864-234-8234
Practice Address - Street 1:100 REGENT PARK CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6534
Practice Address - Country:US
Practice Address - Phone:864-234-3424
Practice Address - Fax:864-234-8234
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9638Medicaid