Organization
TYLAN CREEK FAMILY DENTISTRY GREENWOOD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRYL LEA HALBERT DMD (PRESIDENT)
(864) 407-4455
Entity
Organization
Contact information
Practice address
3710 HIGHWAY 221- 72E, GREENWOOD, SC 29649
(864) 630-9103
(864) 603-2201
Mailing address
330 HARRISON BRIDGE RD, SIMPSONVILLE, SC 29680-7133
(864) 630-9103
(864) 962-6683
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2867
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2867
DENTAL LICENSE
SC
Enumeration date
05/29/2018
Last updated
08/09/2019
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