# EASTSIDE PEDIATRIC DENTISTRY PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841263845
- **Authorized official:** MR. GLENN ROBERT HEAD DMD (OWNER)
- **Authorized official phone:** (864) 233-1234

## Contact information

- **Practice address:** 6 POINTE CIR, GREENVILLE, SC 29615-3506
- **Practice address phone:** (864) 233-1234
- **Practice address fax:** (864) 298-8009
- **Mailing address:** 6 POINTE CIR, GREENVILLE, SC 29615-3506
- **Mailing address phone:** (864) 233-1234
- **Mailing address fax:** (864) 298-8009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 2868 | SC | Yes |

## Other

- **Enumeration date:** 02/09/2006
- **Last updated:** 10/31/2012