Provider Demographics
NPI:1396885331
Name:TOMLINSON, JEAN WEAVER (RDH)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:WEAVER
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 HONDA WAY
Mailing Address - Street 2:
Mailing Address - City:TIMMONSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29161-9415
Mailing Address - Country:US
Mailing Address - Phone:843-346-2648
Mailing Address - Fax:
Practice Address - Street 1:979 HONDA WAY
Practice Address - Street 2:
Practice Address - City:TIMMONSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29161-9415
Practice Address - Country:US
Practice Address - Phone:843-346-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC646124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist