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General NPI Number Information
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NPI Number | 1023485711
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Entity Type | Organization
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Legal Business Name | GREENVILLE SMILES
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 4206 WESLEY ST
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City | GREENVILLE
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State | TX
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Zip | 75401-5638
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Country | US
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Telephone | 903-455-1477
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Fax |
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Provider Business Mailing Address
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Address Line | 4206 WESLEY ST
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City | GREENVILLE
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State | TX
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Zip | 75401-5638
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Country | US
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Telephone | 903-455-1477
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | BENJAMIN HILL
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Credential | DDS
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Telephone | 903-455-1477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 25047
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License Number State | TX
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