Organization
PALMETTO PERIODONTICS PA
Active
Other names
Palmetto Periodontics PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA S RAVENEL DMD,MHS (OWNER)
(864) 987-9700
Entity
Organization
Contact information
Practice address
1130 E BUTLER RD, GREENVILLE, SC 29607-5908
(864) 987-9700
(864) 987-0198
Mailing address
1130 E BUTLER RD, GREENVILLE, SC 29607-5908
(864) 987-9700
(864) 987-0198
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3710
SC
Other
Enumeration date
01/31/2007
Last updated
08/22/2020
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