Provider Demographics
NPI:1306929344
Name:PERIODONTICS OF GREENVILLE
Entity type:Organization
Organization Name:PERIODONTICS OF GREENVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:VOELKERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:864-271-4330
Mailing Address - Street 1:1 CHARIS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6615
Mailing Address - Country:US
Mailing Address - Phone:864-271-4330
Mailing Address - Fax:864-271-0196
Practice Address - Street 1:1 CHARIS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6615
Practice Address - Country:US
Practice Address - Phone:864-271-4330
Practice Address - Fax:864-271-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24961223P0300X
SC38321223P0300X
SC20291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty