Organization
PEDIATRIC DENTISTRY OF GREENVILLE,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM MARTINEZ (OFFICE ASSITANT)
(864) 232-1574
Entity
Organization
Contact information
Practice address
410A PELHAM RD, GREENVILLE, SC 29615-3502
(864) 232-1574
(864) 232-6800
Mailing address
410A PELHAM RD, GREENVILLE, SC 29615-3502
(864) 232-1574
(864) 232-6800
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
ZA9916
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9916
—
SC
Enumeration date
01/09/2006
Last updated
08/22/2020
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