Provider Demographics
NPI:1003022930
Name:GREENVILLE PEDIATRIC DENTISTRY, P.A.
Entity Type:Organization
Organization Name:GREENVILLE PEDIATRIC DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KREIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:903-454-0771
Mailing Address - Street 1:3101 JOE RAMSEY BLVD E
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7716
Mailing Address - Country:US
Mailing Address - Phone:903-454-0771
Mailing Address - Fax:
Practice Address - Street 1:3101 JOE RAMSEY BLVD E
Practice Address - Street 2:SUITE 103A
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7716
Practice Address - Country:US
Practice Address - Phone:903-454-0771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty