=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780851212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROL CLINE STILWELL DMD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2008
-----------------------------------------------------
Last Update Date | 05/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2407 AUGUSTA ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-235-7152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2407 AUGUSTA ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-235-7152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CAROL CLINE STILWELL
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 864-235-7152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2831
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------