Healthcare Provider Details

I. General information

NPI: 1598892028
Provider Name (Legal Business Name): ASHBY PARK PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 REGENT PARK CT
GREENVILLE SC
29607-6534
US

IV. Provider business mailing address

100 REGENT PARK CT
GREENVILLE SC
29607-6534
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-3424
  • Fax: 864-234-8234
Mailing address:
  • Phone: 864-234-3424
  • Fax: 864-234-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3638
License Number StateSC

VIII. Authorized Official

Name: JENNIFER L GARVEY
Title or Position: PRESIDENT
Credential: DMD
Phone: 864-234-3424