Provider Demographics
NPI:1790386613
Name:GRINVILLE DENTISTRY LLC
Entity type:Organization
Organization Name:GRINVILLE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARKS
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-901-6617
Mailing Address - Street 1:114 LAURENS RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1826
Mailing Address - Country:US
Mailing Address - Phone:864-336-8478
Mailing Address - Fax:
Practice Address - Street 1:114 LAURENS RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1826
Practice Address - Country:US
Practice Address - Phone:864-336-8478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental