Provider Demographics
NPI:1720165558
Name:TURNER, JENNIFER BALKCUM (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BALKCUM
Last Name:TURNER
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 1:1202B HWY 72 W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1816
Mailing Address - Country:US
Mailing Address - Phone:864-229-0305
Mailing Address - Fax:864-227-0831
Practice Address - Street 1:1202B HWY 72 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1816
Practice Address - Country:US
Practice Address - Phone:864-229-0305
Practice Address - Fax:864-227-0831
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013175122300000X
SC6721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9184436OtherDORAL
SCZX4112Medicaid