Provider Demographics
NPI:1750542569
Name:BARGANIER, JASON THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:THOMAS
Last Name:BARGANIER
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 1:100 BERKELEY SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2958
Mailing Address - Country:US
Mailing Address - Phone:843-553-5235
Mailing Address - Fax:843-797-8189
Practice Address - Street 1:100 BERKELEY SQUARE LN
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2958
Practice Address - Country:US
Practice Address - Phone:843-553-5235
Practice Address - Fax:843-797-8189
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice