Provider Demographics
NPI:1861496325
Name:LOHSE, JENNIFER ELISABETH (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELISABETH
Last Name:LOHSE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 COLEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4046
Mailing Address - Country:US
Mailing Address - Phone:843-971-1609
Mailing Address - Fax:843-971-1686
Practice Address - Street 1:904 COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4046
Practice Address - Country:US
Practice Address - Phone:843-971-1609
Practice Address - Fax:843-971-1686
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP05671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics