Organization
SEA GLASS PERIODONTICS OF GREENVILLE
Active
Parent organization
SEA GLASS PERIODONTICS, LLC
Other names
Sea Glass Periodontics of Greenville, Diane Jenkins Periodontics of Congaree LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SEA GLASS PERIODONTICS, LLC
Authorized official
MRS. BETH ILLSLEY (DIRECTOR OF INSURANCE)
(864) 282-1935
Entity
Organization
Contact information
Practice address
600 CONGAREE RD, GREENVILLE, SC 29607-3518
(864) 757-8820
(864) 751-6387
Mailing address
400 MEMORIAL DRIVE EXT STE 400, GREER, SC 29651-1850
(864) 282-1935
(864) 751-6387
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
05/14/2020
Last updated
10/09/2024
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