Provider Demographics
NPI:1568192821
Name:MOUNT, JEFFREY TANNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TANNER
Last Name:MOUNT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 STATE PARK RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-2914
Mailing Address - Country:US
Mailing Address - Phone:512-508-6104
Mailing Address - Fax:
Practice Address - Street 1:105 STATE PARK RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-2914
Practice Address - Country:US
Practice Address - Phone:512-508-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice