Organization
LADYS ISLAND DENAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRISTAN H GREENWALT DMD (DENTIST)
(843) 521-0808
Entity
Organization
Contact information
Practice address
5 PROFESSIONAL VILLAGE CIR, BEAUFORT, SC 29907-1571
(843) 521-0808
(843) 521-0945
Mailing address
5 PROFESSIONAL VILLAGE CIR, BEAUFORT, SC 29907-1571
(843) 521-0808
(843) 521-0945
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3760
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
923437
UNITED CONCORDIA
SC
01
—
970484
UNITED CONCORDIA
SC
05
—
ZA9682
—
SC
05
—
ZX3760
—
SC
05
—
ZX3797
—
SC
Enumeration date
03/26/2007
Last updated
08/22/2020
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