Greenville Pediatric Dentistry, P.a.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

19282 Issued in TX

Legal business name

GREENVILLE PEDIATRIC DENTISTRY, P.A.

Practice address

3101 Joe Ramsey Blvd E
Suite 103a
Greenville, TX 75401-7716

Phone

(903) 454-0771

NPI assigned

May 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathryn Ann Kreider, DMD

Title

President

Phone

(903) 454-0771

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003022930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 JOE RAMSEY BLVD E",
            "address_2": "SUITE 103A",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754017716",
            "telephone_number": "903-454-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 JOE RAMSEY BLVD E",
            "address_2": "SUITE 103A",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754017716",
            "telephone_number": "903-454-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE PEDIATRIC DENTISTRY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KREIDER",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-454-0771",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "19282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Greenville, TX
• Providers in Greenville, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.