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General NPI Number Information
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NPI Number | 1841490802
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Entity Type | Organization
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Legal Business Name | PIEDMONT PERIODONTICS
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 3115B BRUSHY CREEK RD
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City | GREER
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State | SC
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Zip | 29650-0903
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Country | US
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Telephone | 864-879-2002
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Fax | 864-879-2004
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Provider Business Mailing Address
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Address Line | 3115B BRUSHY CREEK RD
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City | GREER
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State | SC
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Zip | 29650-0903
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Country | US
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Telephone | 864-879-2002
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Fax | 864-879-2004
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. J. GREGORY SMITH
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Credential | DMD, MHS
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Telephone | 864-879-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3534
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License Number State | SC
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