Provider Demographics
NPI:1235451352
Name:MOUNTAINVIEW DENTISTRY
Entity Type:Organization
Organization Name:MOUNTAINVIEW DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-877-6477
Mailing Address - Street 1:119 VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651
Mailing Address - Country:US
Mailing Address - Phone:864-879-1120
Mailing Address - Fax:864-848-4515
Practice Address - Street 1:119 VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651
Practice Address - Country:US
Practice Address - Phone:864-879-1120
Practice Address - Fax:864-848-4515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHELE K BRYANT, DMD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1904625OtherUNITED CONCORDIA
SCZX4021Medicaid