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General NPI Number Information
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NPI Number | 1033416912
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Entity Type | Organization
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Legal Business Name | PEPPERMINT DENTAL-GREENVILLE PLLC
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 5601 WESLEY ST SUITE A
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City | GREENVILLE
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State | TX
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Zip | 75402-6320
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Country | US
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Telephone | 972-869-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 STATE HIGHWAY 161 SUITE 198
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City | IRVING
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State | TX
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Zip | 75039-2816
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Country | US
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Telephone | 972-869-3789
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MARY PU
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Credential |
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Telephone | 972-869-3789
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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 |
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License Number State |
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