Active NPI
Nancy Marie Mandish, DDS
- Dentist
- Irmo, SC
National Provider Identifier
1013174788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2194
- Practice address
- 1380 Lake Murray Blvd
Irmo, SC 29063-2836 - Phone
- (803) 781-8114
- NPI assigned
- May 20, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2194 | SC | Primary |
Addresses
Primary practice location
1380 Lake Murray Blvd
Irmo, SC 29063-2836
Mailing address
PO Box 2147
Irmo, SC 29063-7147
Phone (803) 781-8114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2194 | SC | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1013174788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2147",
"city": "IRMO",
"state": "SC",
"postal_code": "290637147",
"telephone_number": "803-781-8114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1380 LAKE MURRAY BLVD",
"city": "IRMO",
"state": "SC",
"postal_code": "290632836",
"telephone_number": "803-781-8114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDISH",
"first_name": "NANCY",
"middle_name": "MARIE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-20",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "2194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irmo, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.