Healthcare Provider Details

I. General information

NPI: 1609988005
Provider Name (Legal Business Name): PALMETTO ORTHODONTICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076B WOODRUFF RD
GREENVILLE SC
29607-5939
US

IV. Provider business mailing address

2076B WOODRUFF RD
GREENVILLE SC
29607-5939
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-7357
  • Fax: 864-627-8316
Mailing address:
  • Phone: 864-234-7357
  • Fax: 864-627-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1613
License Number StateSC

VIII. Authorized Official

Name: DR. CHARLES DAVID ATKINSON
Title or Position: OWNER
Credential: DDS, MSD
Phone: 864-234-7357