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NPI Code Detail

MEDICARE: PEDIATRIC DENTISTRY OF GREENWOOD, P.A.

MEDICARE: PEDIATRIC DENTISTRY OF GREENWOOD, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric DentistrySC4112SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215188388
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC DENTISTRY OF GREENWOOD, P.A.
Provider Business Mailing Address
First Line : 1202B HWY 72 W
Second Line :
City : GREENWOOD
State : SC
Zip : 29649-1816
Country : US
Telephone Number : 864-229-0305
Fax Number :
Provider Business Practice Location Address
First Line : 1202B HWY 72 W
Second Line :
City : GREENWOOD
State : SC
Zip : 29649-1816
Country : US
Telephone Number : 864-229-0305
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. JENNIFER BALKCUM TURNER
Credential :
Telephone Number : 864-229-0305
Provider Enumeration Date : 10/07/2008
Last Update Date : 10/07/2008

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1228 HIGHWAY 72 W
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1922092345 — DR. BRYAN K ELLENBERG MD
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1538153861 — DR. JOHN M ERGLE MD
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29649-1816
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Practice Fax: 864-227-2067
1366413833 — DR. JOHN VINCENT MAYLOCK M.D.
Practice Location Address:
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GREENWOOD, SC
29649-1816
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Practice Fax: 864-227-2067
1407887318 — PHILLIP WAYNE JANSEN D.O.
Practice Location Address:
1228 HIGHWAY 72 W
GREENWOOD, SC
29649-1816
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Practice Fax:
1720165558 — DR. JENNIFER BALKCUM TURNER D.M.D.
Practice Location Address:
1202B HWY 72 W
GREENWOOD, SC
29649-1816
Practice Phone: 864-229-0305
Practice Fax: 864-227-0831

Directions to “PEDIATRIC DENTISTRY OF GREENWOOD, P.A. ” Practice Location

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