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General NPI Number Information
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NPI Number | 1891286613
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Entity Type | Organization
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Legal Business Name | TYLAN CREEK FAMILY DENTISTRY GREENWOOD
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 3710 HIGHWAY 221- 72E
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City | GREENWOOD
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State | SC
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Zip | 29649
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Country | US
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Telephone | 864-630-9103
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Fax | 864-603-2201
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Provider Business Mailing Address
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Address Line | 330 HARRISON BRIDGE RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-7133
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Country | US
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Telephone | 864-630-9103
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Fax | 864-962-6683
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARRYL LEA HALBERT
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Credential | DMD
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Telephone | 864-407-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2867
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License Number State | SC
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