Organization
SEA GLASS PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETH ILLSLEY (DIRECTOR OF INSURANCE)
(864) 282-1935
Entity
Organization
Contact information
Practice address
400 MEMORIAL DRIVE EXT STE 400, GREER, SC 29651-1850
(864) 282-1935
(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
7146/788
SC
Other
Enumeration date
05/27/2015
Last updated
10/09/2024
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