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Organization

GREENVILLE YOUTH DENTISTRY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JENELL STUMP (MANAGER, LICENSING & CREDENTIALING)
(615) 750-0343
Entity
Organization

Contact information

Practice address
225 S PLEASANTBURG DR, SUITE E10, GREENVILLE, SC 29607-2544
(864) 233-7737
(864) 233-6559
Mailing address
16 ARCADE UNIT 198747, NASHVILLE, TN 37219-1994
(615) 750-0343
(615) 986-1705

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
ZA9485
SC
Enumeration date
06/12/2006
Last updated
07/09/2014
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