Healthcare Provider Details

I. General information

NPI: 1932504230
Provider Name (Legal Business Name): SD GREENVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 WESLEY ST
GREENVILLE TX
75402-6307
US

IV. Provider business mailing address

10901 GARLAND RD
DALLAS TX
75218-2613
US

V. Phone/Fax

Practice location:
  • Phone: 903-454-2336
  • Fax: 903-454-2382
Mailing address:
  • Phone: 214-466-1400
  • Fax: 214-367-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNHTHY T PHAM
Title or Position: OWNER/ DENTIST
Credential: DDS
Phone: 214-466-1400