Provider Demographics
NPI:1003983305
Name:GREENVILLE FAMILY DENTAL, PC
Entity Type:Organization
Organization Name:GREENVILLE FAMILY DENTAL, PC
Other - Org Name:GREENVILLE FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-966-5323
Mailing Address - Street 1:44 BRYANTS COUNTRY SQUARE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12083
Mailing Address - Country:US
Mailing Address - Phone:518-966-5323
Mailing Address - Fax:
Practice Address - Street 1:44 BRYANTS COUNTRY SQUARE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12083
Practice Address - Country:US
Practice Address - Phone:518-966-5323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty