Jeanine Alicia Gourdine, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4061 Issued in SC

Practice address

100 Omalley Dr
Suite B
Summerville, SC 29483-5635

Phone

(843) 261-0123

Fax

(843) 261-0125

NPI assigned

Apr 25, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Smile Center of Knightsville

  • General Practice Dentistry
  • Summerville, SC
  • NPI 1558543249
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505260800000",
    "number": "1427014786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "address_2": "SUITE B",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295511090",
            "telephone_number": "843-857-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 OMALLEY DR",
            "address_2": "SUITE B",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294835635",
            "telephone_number": "843-261-0123",
            "fax_number": "843-261-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURDINE",
        "first_name": "JEANINE",
        "middle_name": "ALICIA",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2017-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX4061",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcia Michelle Goodwin, PHARMD
• Verdeanis P Goodwine
• Mallory Brooke Gore, M.S., CCC-SLP
• Amelia B Gorsuch, RPH
• Taylor Brooke Goude
• Sanquan Govan
• Grace Physical Therapy, LLC
• Anna Hayes Graf
• Allison Paige Graham, M.S. CCC-SLP
• Curtis Graham, LPC

• General Practice Dentistry in Summerville, SC
• Providers in Summerville, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.