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Organization
SEA GLASS PERIODONTICS OF SIMPSONVILLE LLC
Active
Organization
SEA GLASS PERIODONTICS OF SIMPSONVILLE LLC
Active
Parent organization
SEA GLASS PERIODONTICS
Organization subpart
Yes
Provider details
NPI number
Legal business name
SEA GLASS PERIODONTICS
Authorized official
BETH ILLSLEY (DIRECTOR OF INSURANCE)
(864) 282-1935
Entity
Organization
Contact information
Practice address
110A HOSPITAL DR, SIMPSONVILLE, SC 29681-3226
(864) 757-8820
(864) 751-6387
Mailing address
400 MEMORIAL DRIVE EXT STE 400, GREER, SC 29651-1850
(864) 282-1935
(864) 751-6387
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
07/30/2020
Last updated
07/30/2020
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