DIANE JENKINS PERIODONTICS OF CONGAREE, LLC (NPI# 1568084408) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568084408 |
| Entity Type | Organization |
| Organization Name | DIANE JENKINS PERIODONTICS OF CONGAREE, LLC |
| Other Organization Name | DIANE JENKINS PERIODONTICS OF CONGAREE LLC |
| Practice Address |
600 Congaree Rd Greenville SC 29607-3518 |
| Mailing Address |
400 Memorial Drive Ext Ste 400 Greer SC 29651-1850 |
| Practice Telephone | 8647578820 |
| Practice Fax Number | 8647516387 |
| Mailing Telephone | 8642821935 |
| Mailing Fax Number | 8647516387 |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2020-10-05 |
| Authorized Official Name | MRS. BETH ILLSLEY (DIRECTOR OF INSURANCE) |
| Authorized Official Telephone | 8642821935 |
| Is Organization Subpart | Y |
| Parent Organization Name | SEA GLASS PERIODONTICS, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Diane Jenkins Periodontics of Congaree LLC | Former Legal Business Name - Organization |
| Sea Glass Periodontics of Greenville | Doing Business As Name - Organization |
| Street Address |
600 CONGAREE RD |
| City | GREENVILLE |
| State | SC |
| Zip Code | 29607-3518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245846138 | Personalized Home Care Services | Technician | 1200 Woodruff Rd A3 Ste 150, Greenville, SC 29607 | 2020-09-16 |
| 1396361960 | Complete Homecare of America, Inc. | In Home Supportive Care | 128 Millport Circle, Suite 200, Greenville, SC 29607 | 2020-06-19 |
| 1275175093 | Carrie Laxton Ballenger | Nurse Practitioner | 2094 Woodruff Road, Greenville, SC 29607 | 2019-10-14 |
| 1861047037 | Susannah Long | Marriage & Family Therapist | 109 Laurens Road, Building 4 Ste D, Greenville, SC 29607 | 2019-08-05 |
| 1043872369 | Cheryl Craig Rosemond | Case Manager/Care Coordinator | 5 Century Drive, Suite 130, Greenville, SC 29607 | 2019-07-08 |
| 1457916561 | After Hours Chiropractic LLC | Chiropractor | 1200 Woodruff Rd Blg A-3, Simpsonville, SC 29607 | 2019-05-03 |
| 1952865289 | Orthodontic Specialists of Carolina, PC | Dentist | 611 Haywood Road, Greenville, SC 29607 | 2019-01-31 |
| 1124502307 | Martha Irby | Home Health Aide | 2320 E North St Rr 107, Greenville, SC 29607 | 2018-09-24 |
| 1780164541 | Suval Psychiatric Services, Pa | Clinic/Center | 33 Market Point Dr Ste 2023, Greenville, SC 29607 | 2018-08-20 |
| 1083113963 | Caroline Graham | Nurse Practitioner | 850 S Pleasantburg Dr, Greenville, SC 29607 | 2018-02-06 |
| Find all providers in zip 29607 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649725102 | Carolina Periodontics & Dental Implants | Dentist | 112 W Broad St Unit 405, Greenville, SC 29601-2688 | 2016-08-24 |
| 1699844522 | Patrick L Johnson | Dentist | 108 Oakmont Dr, Greenville, NC 27858-5936 | 2006-11-07 |
| 1306929344 | Periodontics of Greenville | Dentist | 1 Charis Dr, Greenville, SC 29615-6615 | 2006-10-23 |
| 1194823633 | Janet Roberts Edwards | Dentist | 517 West Butler Road, Greenville, SC 29607 | 2006-09-20 |
| 1891703419 | Lisa S Ravenel | Dentist | 1130 E Butler Rd, Greenville, SC 29607-5908 | 2006-08-03 |
| 1013569771 | Ravenel Periodontics, Pa | Dentist | 1130 E Butler Rd, Greenville, SC 29607-5908 | 2019-07-12 |
| 1588105829 | Periodontics of Greenville | Dentist | 1130 E Butler Rd, Greenville, SC 29607-5908 | 2017-03-20 |
| 1598178030 | Alex Gillone | Dentist | 1851 Macgregor Downs Rd, Greenville, NC 27834-5925 | 2014-06-03 |
| 1811309321 | Acela Alejandra Martinez Luna | Dentist | 1851 Macgregor Downs Rd, Greenville, NC 27834-5925 | 2014-06-02 |
| 1205177797 | Maged Abdelaal | Dentist | 1851 Macgregor Downs Rd, Greenville, NC 27834-5925 | 2013-03-07 |
| Find all providers in GREENVILLE | ||||
| City | GREENVILLE |
| Zip Code | 29607 |
Please comment or provide details below to improve the information on DIANE JENKINS PERIODONTICS OF CONGAREE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.