Provider Demographics
NPI:1841260197
Name:JABLON, HAROLD WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:WILLIAM
Last Name:JABLON
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 1:171 ASPEN TRL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-4978
Mailing Address - Country:US
Mailing Address - Phone:803-787-2387
Mailing Address - Fax:803-787-2387
Practice Address - Street 1:725 GREENLAWN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2658
Practice Address - Country:US
Practice Address - Phone:803-783-0525
Practice Address - Fax:803-776-1105
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9566Medicaid
SCZ16377Medicaid