Palmetto Periodontics PA

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

3710 Issued in SC

Legal business name

PALMETTO PERIODONTICS PA

Doing business as

Palmetto Periodontics PA

Practice address

1130 E Butler Rd
Greenville, SC 29607-5908

Phone

(864) 987-9700

Fax

(864) 987-0198

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lisa S Ravenel, DMD,MHS

Title

Owner

Phone

(864) 987-9700

Specialties & licenses 1

Addresses

Other names 1

• Palmetto Periodontics PA Doing business as

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316084197",
    "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 PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RAVENEL",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-987-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD,MHS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "SC",
            "license": "3710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palmetto Periodontics PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.