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General NPI Number Information
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NPI Number | 1912196684
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Entity Type | Organization
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Legal Business Name | PALMETTO FAMILY ORTHODONTICS LLC
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 105 HALTON VILLAGE CIR SUITE B
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City | GREENVILLE
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State | SC
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Zip | 29607-6833
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Country | US
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Telephone | 864-335-0505
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Fax | 864-335-0508
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Provider Business Mailing Address
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Address Line | 105 HALTON VILLAGE CIR SUITE B
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City | GREENVILLE
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State | SC
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Zip | 29607-6833
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Country | US
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Telephone | 864-335-0505
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Fax | 864-335-0508
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. DAVID F WATSON III
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Credential | DMD MPH
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Telephone | 864-335-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4287
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 681
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License Number State | SC
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