Provider Demographics
NPI:1639297385
Name:GREER, KYLE S (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:S
Last Name:GREER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27143
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-2143
Mailing Address - Country:US
Mailing Address - Phone:864-297-6365
Mailing Address - Fax:864-297-9949
Practice Address - Street 1:3369 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4105
Practice Address - Country:US
Practice Address - Phone:864-297-6365
Practice Address - Fax:864-297-9949
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3262Medicaid