Sea Glass Periodontics of Simpsonville LLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

SEA GLASS PERIODONTICS OF SIMPSONVILLE LLC

Practice address

110A Hospital Dr
Simpsonville, SC 29681-3226

Phone

(864) 757-8820

Fax

(864) 751-6387

NPI assigned

Jul 30, 2020

Organization subpart

Yes

Parent organization

SEA GLASS PERIODONTICSAs reported in NPPES

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

Authorized official

Name

Beth Illsley

Title

Director of Insurance

Phone

(864) 282-1935

Specialties & licenses 1

Addresses

Part of

Sea Glass Periodontics of Greenville

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Sea Glass Periodontics

  • Periodontics
  • Greer, SC
  • NPI 1043699770
  NPPES parent name

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1295344646",
    "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": "110A HOSPITAL DR",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296813226",
            "telephone_number": "864-757-8820",
            "fax_number": "864-751-6387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEA GLASS PERIODONTICS OF SIMPSONVILLE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEA GLASS PERIODONTICS",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "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"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Schwalm, MD
• Stacey Scott
• Starr Scott
• Ryan Scroggs, DC
• Angela T Scruggs, MAMFC
• Hannah Elizabeth Sears
• Brittany Segriff
• Charmaine Seguro
• Holly Seppala-Williams, REGISTERED NURSE
• Set Counseling

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.