| Greenville Smiles P.a. | |
|
140 Mall Connector Rd Suite 6a Greenville SC 29607 | |
| (864) 244-7135 | |
| (864) 268-2428 |
| Full Name | Greenville Smiles P.a. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 140 Mall Connector Rd, Greenville, South Carolina |
| Authorized Official Name and Position | Ronald Stanley Wilson (DENTIST/OWNER) |
| Authorized Official Contact | 8642447135 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenville Smiles P.a. 140 Mall Connector Rd Suite 6a Greenville SC 29607 Ph: (864) 244-7135 | Greenville Smiles P.a. 140 Mall Connector Rd Suite 6a Greenville SC 29607 Ph: (864) 244-7135 |
| NPI Number | 1144300708 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 06/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144300708 | NPI | - | NPPES |
| ZA9622 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3603 (South Carolina) | Primary |
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