Sea Glass Periodontics

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

7146/788 Issued in SC

Legal business name

SEA GLASS PERIODONTICS

Practice address

400 Memorial Drive Ext Ste 400
Greer, SC 29651-1850

Phone

(864) 282-1935

Fax

(864) 751-6387

NPI assigned

May 27, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Beth Illsley

Title

Director of Insurance

Phone

(864) 282-1935

Specialties & licenses 1

Addresses

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Sea Glass Periodontics of Greenville

  • Periodontics
  • Greenville, SC
  • NPI 1568084408
  NPPES parent name
• Sea Glass Periodontics of Simpsonville LLC

  • Periodontics
  • Simpsonville, SC
  • NPI 1295344646
  NPPES parent name

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

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1043699770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MEMORIAL DRIVE EXT STE 400",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296511850",
            "telephone_number": "864-282-1935",
            "fax_number": "864-751-6387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MEMORIAL DRIVE EXT STE 400",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296511850",
            "telephone_number": "864-282-1935",
            "fax_number": "864-751-6387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEA GLASS PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-27",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "ILLSLEY",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "DIRECTOR OF INSURANCE",
        "authorized_official_telephone_number": "864-282-1935",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "SC",
            "license": "7146/788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Joseph Schmitt
• Natalie Schmutz, DPT
• Paulyna Maryann Schulz
• Sabrina Scott-McCrea
• Teresa P Scott, RPH.
• Wayne Franklin Sease Jr., M.D.
• Seasons Child & Family Wellness
• Erin Seawright, MD
• Claudia Lynn Seay, DC
• Julie J Segars, SLP

• Periodontics in Greer, SC
• Providers in Greer, SC by specialty
• Periodontics in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.