SFD Kids LLC

Primary specialty

DentistTaxonomy code 122300000X

License

8227 Issued in SC

Legal business name

SFD KIDS LLC

Practice address

108 Parish Farms Drive
Summerville, SC 29486

Phone

(843) 871-0842

NPI assigned

Feb 13, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Angela Bazzle

Title

Operations Manager

Phone

(843) 871-0842

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486944000000",
    "number": "1013456987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1971 N MAIN ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294867820",
            "telephone_number": "843-871-0842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 PARISH FARMS DRIVE",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "29486",
            "telephone_number": "843-871-0842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SFD KIDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2017-02-13",
        "status": "A",
        "authorized_official_last_name": "BAZZLE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "843-871-0842",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "8227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX8227",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Summerville, SC
• Providers in Summerville, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; 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.