Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | SC 8213 | SC |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 04441 | NH |
NPI | 1326308628 |
---|---|
Provider Name | Dr. Jonathan Bean |
First Address | Columbia, SC 29223-6416 |
Second Address | Columbia, SC 29223-6416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2012 |
Last Update Date | 21/06/2021 |