| Greenville Pediatric Dentistry Pa | |
|
1376 Cleveland St Greenville SC 29607-2435 | |
| (864) 250-1100 | |
| (864) 250-1604 |
| Full Name | Greenville Pediatric Dentistry Pa |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1376 Cleveland St, Greenville, South Carolina |
| Authorized Official Name and Position | Tammy Knight Porter (INSURANCE CLAIMS MANAGER) |
| Authorized Official Contact | 8642501100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenville Pediatric Dentistry Pa 1376 Cleveland St Greenville SC 29607-2435 Ph: (864) 250-1100 | Greenville Pediatric Dentistry Pa 1376 Cleveland St Greenville SC 29607-2435 Ph: (864) 250-1100 |
| NPI Number | 1366522922 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 06/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366522922 | NPI | - | NPPES |
| ZA9752 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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