NPIMap

Organization Active NPI

Greenville Pediatric Dentistry PA

  • Pediatric Dentistry
  • Greenville, SC
National Provider Identifier
1366522922
Registry record updated Jun 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
GREENVILLE PEDIATRIC DENTISTRY PA
Practice address
1376 Cleveland St
Greenville, SC 29607-2435
Phone
(864) 250-1100
Fax
(864) 250-1604
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2010

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

Authorized official

Name
Mrs. Tammy Knight Porter
Title
Insurance Claims Manager
Phone
(864) 250-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

1376 Cleveland St
Greenville, SC 29607-2435

Mailing address

1376 Cleveland St
Greenville, SC 29607-2435
Phone (864) 250-1100

Other identifiers 1

IdentifierTypeStateIssuer
ZA9752MedicaidSC

Other names 1

  • Drs. Wilson, Uprichard and Czarsty PA Former legal business name

National Provider Directory

National Provider Directory

Locations

1376 Cleveland St
Greenville, SC 29607
Phone (864) 250-1100

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276128000000",
    "number": "1366522922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1376 CLEVELAND ST",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296072435",
            "telephone_number": "864-250-1100",
            "fax_number": "864-250-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1376 CLEVELAND ST",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296072435",
            "telephone_number": "864-250-1100",
            "fax_number": "864-250-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE PEDIATRIC DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2010-06-10",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "KNIGHT",
        "authorized_official_title_or_position": "INSURANCE CLAIMS MANAGER",
        "authorized_official_telephone_number": "864-250-1100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9752",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. Wilson, Uprichard and Czarsty PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Jun 10, 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.