Eastside Pediatric Dentistry PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2868 Issued in SC

Legal business name

EASTSIDE PEDIATRIC DENTISTRY PA

Practice address

6 Pointe Cir
Greenville, SC 29615-3506

Phone

(864) 233-1234

Fax

(864) 298-8009

NPI assigned

Feb 9, 2006

Last updated

Oct 31, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Glenn Robert Head, DMDNPI 1790771871

Title

Owner

Phone

(864) 233-1234

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glenn Robert Head, D.M.D.

  • Pediatric Dentistry
  • Greenville, SC
  • NPI 1790771871
  NPD (past) Authorized official
• Jori Falcon, DMD

  • Pediatric Dentistry
  • Greenville, SC
  • NPI 1265407159
  NPD (past)

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351641600000",
    "number": "1841263845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 POINTE CIR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153506",
            "telephone_number": "864-233-1234",
            "fax_number": "864-298-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 POINTE CIR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153506",
            "telephone_number": "864-233-1234",
            "fax_number": "864-298-8009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE PEDIATRIC DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-09",
        "last_updated": "2012-10-31",
        "status": "A",
        "authorized_official_last_name": "HEAD",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-233-1234",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "2868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Florencia Eastlack, M.D.
• Eastside Counseling Service
• Eastside Hematology Oncology
• Eastside Internal Med
• Eastside Manor Inc. Dba Southern Oaks
• Eating Recovery Center-the Carolinas
• Andrew Christopher Eaton
• Lynsey Yulee Ebel, D.O.
• Natalie Elizabeth Ebeling-Koning
• Arthur Lee Eberly III, MD

• Pediatric Dentistry in Greenville, SC
• Providers in Greenville, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; 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.