Greenwalt, Tristan
Greenwalt, Tristan is an individual health care provider with primary practice located at 5 Professional Village Cir , Beaufort SC 29907-1571. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Greenwalt, Tristan can be contacted via phone (843) 521-0808.Contact Information
Primary practice address
5 Professional Village Cir
Beaufort SC 29907-1571
Phone: (843) 521-0808
Fax: (843) 521-0945
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 3760 | South Carolina |
Profile Details
| NPI number | 1518940980 |
|---|---|
| LBN Legal business name | Greenwalt, Tristan |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 21st, 2005 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518940980 | NPPES |
| South Carolina | MEDICAID | ZA9682 |
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