Healthcare Provider Details

I. General information

NPI: 1780640839
Provider Name (Legal Business Name): KENTON R. HOLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GREGOR MENDEL CIR
GREENWOOD SC
29646-2316
US

IV. Provider business mailing address

PO BOX 1047 GREENWOOD GENETIC CENTER-MT. PLEASANT OFFICE
MT PLEASANT SC
29465-1047
US

V. Phone/Fax

Practice location:
  • Phone: 864-941-8100
  • Fax: 864-941-8114
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberC47743
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: