Greenville Smiles P.a.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3603 Issued in SC

Legal business name

GREENVILLE SMILES P.A.

Practice address

140 Mall Connector Rd
Suite 6a
Greenville, SC 29607

Phone

(864) 244-7135

Fax

(864) 268-2428

NPI assigned

Oct 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ronald Stanley Wilson, DMDNPI 1730269382

Title

Dentist/Owner

Phone

(864) 244-7135

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Greenville Family & Implant Dentistry Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ronald Stanley Wilson, DMD

  • General Practice Dentistry
  • Greenville, SC
  • NPI 1730269382
  NPD (past) Authorized official

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1144300708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 MALL CONNECTOR RD",
            "address_2": "SUITE 6A",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29607",
            "telephone_number": "864-244-7135",
            "fax_number": "864-268-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 MALL CONNECTOR RD",
            "address_2": "SUITE 6A",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29607",
            "telephone_number": "864-244-7135",
            "fax_number": "864-268-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE SMILES P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "864-244-7135",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9622",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenville Family & Implant Dentistry",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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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 21, 2018; 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.