Basic Information
| Provider Information | |||||||||
| NPI: | 1922386747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOWER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | MATTISON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 347 RED CEDAR STREET | ||||||||
| Address2: | BUILDING 400 | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438156500 | ||||||||
| FaxNumber: | 8438156501 | ||||||||
| Practice Location | |||||||||
| Address1: | 347 RED CEDAR STREET | ||||||||
| Address2: | BUILDING 400 | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438156500 | ||||||||
| FaxNumber: | 8438156501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2011 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | NC9184 | NC | N | Dental Providers | Dentist | 122300000X | 7123 | SC | Y | Dental Providers | Dentist |
No ID Information.