Greenville Avenue Dentistry, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GREENVILLE AVENUE DENTISTRY, PC

Doing business as

Greenville Avenue Dentistry

Practice address

3116 N Pleasantburg Dr Ste 400
Greenville, SC 29609-3757

Phone

(864) 565-7132

Fax

(864) 568-3813

NPI assigned

Jun 14, 2022

Organization subpart

No

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

Authorized official

Name

Ali Shahrestani, DMD

Title

Owner

Phone

(864) 565-7132

Specialties & licenses 1

Addresses

Other names 1

• Greenville Avenue Dentistry Doing business as

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1033849997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3116 N PLEASANTBURG DR STE 400",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296093757",
            "telephone_number": "864-565-7132",
            "fax_number": "864-568-3813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE AVENUE DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-14",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "SHAHRESTANI",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-565-7132",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenville Avenue Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Greenville, SC
• Providers in Greenville, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; 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.