Provider Demographics
NPI:1922386747
Name:GOWER, JESSICA MATTISON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MATTISON
Last Name:GOWER
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 1:347 RED CEDAR STREET
Mailing Address - Street 2:BUILDING 400
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:843-815-6500
Mailing Address - Fax:843-815-6501
Practice Address - Street 1:347 RED CEDAR STREET
Practice Address - Street 2:BUILDING 400
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-815-6500
Practice Address - Fax:843-815-6501
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC9184122300000X
SC7123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist