NPIMap

Organization Active NPI

Dental Professionals of South Carolina, P.C.

  • Dentist
  • Greenville, SC
National Provider Identifier
1013302785
Registry record updated May 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3791 Issued in SC
Legal business name
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Practice address
303 Ashby Park LN
Greenville, SC 29607-6903
Phone
(864) 987-5578
Fax
(864) 987-0351
NPI assigned
Mar 31, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cassandra Petersen
Title
Credentialing Team Lead
Phone
(217) 540-8972

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 3791 SC Primary

Addresses

Primary practice location

303 Ashby Park LN
Greenville, SC 29607-6903

Mailing address

303 Ashby Park LN
Greenville, SC 29607-6903
Phone (864) 987-5578

Other names 1

  • Ashby Park Restorative and Cosmetic Dentistry PA Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professional of South Carolina PC74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

303 Ashby Park Ln
Greenville, SC 29607
Phone (864) 987-5578

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525651200000",
    "number": "1013302785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 ASHBY PARK LN",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296076903",
            "telephone_number": "864-987-5578",
            "fax_number": "864-987-0351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 ASHBY PARK LN",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296076903",
            "telephone_number": "864-987-5578",
            "fax_number": "864-987-0351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-31",
        "last_updated": "2018-05-07",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8972"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "3791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ashby Park Restorative and Cosmetic Dentistry PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.