Provider Demographics
NPI:1215615638
Name:KNOWLTON, JESSE BEASLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:BEASLEY
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1860
Mailing Address - Country:US
Mailing Address - Phone:803-877-6703
Mailing Address - Fax:
Practice Address - Street 1:2590 TAHOE DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1860
Practice Address - Country:US
Practice Address - Phone:803-877-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice