Provider Demographics
NPI:1992316053
Name:CHILDRENS DENTISTRY OF GREENVILLE
Entity type:Organization
Organization Name:CHILDRENS DENTISTRY OF GREENVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-235-3949
Mailing Address - Street 1:200 S PLEASANTBURG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2522
Mailing Address - Country:US
Mailing Address - Phone:864-235-3949
Mailing Address - Fax:
Practice Address - Street 1:410 PELHAM RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3502
Practice Address - Country:US
Practice Address - Phone:864-232-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental