Provider Demographics
NPI:1043361512
Name:GENTLE DENTAL CARE OF GREENVILLE
Entity Type:Organization
Organization Name:GENTLE DENTAL CARE OF GREENVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-235-4848
Mailing Address - Street 1:2400 N PLEASANTBURG DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-2706
Mailing Address - Country:US
Mailing Address - Phone:864-235-4848
Mailing Address - Fax:864-331-8619
Practice Address - Street 1:2400 N PLEASANTBURG DR
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-2706
Practice Address - Country:US
Practice Address - Phone:864-235-4848
Practice Address - Fax:864-331-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty