# PEDIATRIC DENTISTRY OF GREENVILLE,P.A.

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

## Provider details

- **NPI number:** 1902884984
- **Authorized official:** MRS. KIM MARTINEZ (OFFICE ASSITANT)
- **Authorized official phone:** (864) 232-1574

## Contact information

- **Practice address:** 410A PELHAM RD, GREENVILLE, SC 29615-3502
- **Practice address phone:** (864) 232-1574
- **Practice address fax:** (864) 232-6800
- **Mailing address:** 410A PELHAM RD, GREENVILLE, SC 29615-3502
- **Mailing address phone:** (864) 232-1574
- **Mailing address fax:** (864) 232-6800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | ZA9916 | SC | Yes |

## Other

- **Enumeration date:** 01/09/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZA9916 | — | SC |