| NPI | 1568084408 |
|---|---|
| Former Legal Business Name | DIANE JENKINS PERIODONTICS OF CONGAREE LLC |
| Doing Business As | SEA GLASS PERIODONTICS OF GREENVILLE |
| Entity Type | Organization |
| Authorized Contact | BETH ILLSLEY Director Of Insurance 864-282-1935 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2024-10-09 |