NPIMap

Organization Active NPI

Palmetto Periodontics of Greenville PA

  • Periodontics
  • Greenville, SC
National Provider Identifier
1124332465
Registry record updated Jul 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
6919 Issued in SC
Legal business name
PALMETTO PERIODONTICS OF GREENVILLE PA
Practice address
1130 E Butler Rd
Greenville, SC 29607-5908
Phone
(864) 987-9700
Fax
(864) 987-0198
NPI assigned
Jul 28, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2010

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

Authorized official

Name
Dr. William Fredrick Bohlen, DMD
Title
Owner
Phone
(864) 987-9700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 6919 SC Primary

Addresses

Primary practice location

1130 E Butler Rd
Greenville, SC 29607-5908

Mailing address

1130 E Butler Rd
Greenville, SC 29607-5908
Phone (864) 987-9700

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280275200000",
    "number": "1124332465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 E BUTLER RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296075908",
            "telephone_number": "864-987-9700",
            "fax_number": "864-987-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 E BUTLER RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296075908",
            "telephone_number": "864-987-9700",
            "fax_number": "864-987-0198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO PERIODONTICS OF GREENVILLE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-28",
        "last_updated": "2010-07-28",
        "status": "A",
        "authorized_official_last_name": "BOHLEN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "FREDRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-987-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "SC",
            "license": "6919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; 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.