Organization
KOOL SMILES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA C BLACK DMD (DENTIST)
(510) 290-4744
Entity
Organization
Contact information
Practice address
3227 W BLUE RIDGE DR, GREENVILLE, SC 29611-3905
(510) 290-4744
Mailing address
PO BOX 67, TAYLORS, SC 29687-0002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4543
SC
1223P0221X
Pediatric Dentistry
4543
SC
Other
Enumeration date
11/17/2006
Last updated
10/21/2009
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