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General NPI Number Information
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NPI Number | 1902884984
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF GREENVILLE,P.A.
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 410A PELHAM RD
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City | GREENVILLE
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State | SC
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Zip | 29615-3502
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Country | US
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Telephone | 864-232-1574
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Fax | 864-232-6800
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Provider Business Mailing Address
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Address Line | 410A PELHAM RD
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City | GREENVILLE
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State | SC
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Zip | 29615-3502
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Country | US
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Telephone | 864-232-1574
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Fax | 864-232-6800
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Authorized Official
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Title or Position | OFFICE ASSITANT
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Name | MRS. KIM MARTINEZ
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Credential |
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Telephone | 864-232-1574
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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 | ZA9916
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License Number State | SC
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