Organization · Type 2 NPI

Sea Glass Periodontics of Greenville

Periodontics · Greenville, SC

NPI number 1568084408 Active

Practice location

600 Congaree Rd
Greenville, SC 29607-3518

Call (864) 757-8820 Map

Fax (864) 751-6387

Mailing address

400 Memorial Drive Ext Ste 400
Greer, SC 29651-1850

Specialties and licenses

Taxonomy	Code	License
Periodontics Primary	1223P0300X	None listed

Periodontics: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Another provider at this address

Stephanie Irene Drake, DDSPeriodontics Greenville, SC NPI 1376287441

Other periodontics providers in Greenville

See all in Greenville →

NPI record

NPI: 1568084408
Entity type: Organization (Type 2)
Issued: May 14, 2020
Last updated: Oct 9, 2024
Status: Active
Subpart: Yes of Sea Glass Periodontics, LLC

Other names

<unavail>
Sea Glass Periodontics of Greenville · doing business as
Diane Jenkins Periodontics of Congaree LLC · former legal business name
Diane Jenkins Periodontics of Congaree LLC · former legal business name

Authorized official

Mrs. Beth Illsley
Director of Insurance
(864) 282-1935

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1568084408

Sea Glass Periodontics of Greenville's National Provider Identifier is 1568084408, issued on May 14, 2020. The primary taxonomy on file is Periodontics (1223P0300X), and the practice location is in Greenville, SC. The record was last updated on Oct 9, 2024.