Organization
RIVERSIDE PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT MOISTER (OWNER)
(864) 697-2009
Entity
Organization
Contact information
Practice address
24 MEMORIAL MEDICAL DR, GREENVILLE, SC 29605
(864) 697-2009
(864) 697-2009
Mailing address
24 MEMORIAL MEDICAL DR STE 106-102, GREENVILLE, SC 29605-4452
(864) 697-2009
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
36140
SC
Other
Enumeration date
09/03/2013
Last updated
07/18/2018
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