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General NPI Number Information
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NPI Number | 1083008890
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Entity Type | Organization
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Legal Business Name | HOLLY TREE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 1334 HIGHWAY 14
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-5659
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Country | US
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Telephone | 864-297-5585
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Fax | 864-297-4166
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Provider Business Mailing Address
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Address Line | 1334 HIGHWAY 14
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-5659
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Country | US
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Telephone | 864-297-5585
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Fax | 864-297-4166
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANN BYNUM
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Credential | DDS
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Telephone | 864-297-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3427
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License Number State | SC
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