# GREENVILLE PEDIATRIC DENTISTRY PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Drs. Wilson, Uprichard and Czarsty PA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366522922
- **Authorized official:** MRS. TAMMY KNIGHT PORTER (INSURANCE CLAIMS MANAGER)
- **Authorized official phone:** (864) 250-1100

## Contact information

- **Practice address:** 1376 CLEVELAND ST, GREENVILLE, SC 29607-2435
- **Practice address phone:** (864) 250-1100
- **Practice address fax:** (864) 250-1604
- **Mailing address:** 1376 CLEVELAND ST, GREENVILLE, SC 29607-2435
- **Mailing address phone:** (864) 250-1100
- **Mailing address fax:** (864) 250-1604

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 10/17/2006
- **Last updated:** 06/10/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZA9752 | — | SC |