Provider Demographics
NPI:1558422287
Name:JENNINGS, HAROLD C (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:C
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4076
Mailing Address - Country:US
Mailing Address - Phone:864-233-1533
Mailing Address - Fax:864-233-1152
Practice Address - Street 1:310 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4076
Practice Address - Country:US
Practice Address - Phone:864-233-1533
Practice Address - Fax:864-233-1152
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice