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Organization
TYLAN CREEK FAMILY DENTISTRY GREENWOOD
Active
Organization
TYLAN CREEK FAMILY DENTISTRY GREENWOOD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRYL LEA HALBERT DMD (PRESIDENT)
(864) 407-4455
Entity
Organization
Contact information
Practice address
3710 HIGHWAY 221- 72E, GREENWOOD, SC 29649
(864) 630-9103
(864) 603-2201
Mailing address
330 HARRISON BRIDGE RD, SIMPSONVILLE, SC 29680-7133
(864) 630-9103
(864) 962-6683
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2867
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2867
DENTAL LICENSE
SC
Enumeration date
05/29/2018
Last updated
08/09/2019
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