Craig Steven Modzelewski, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3892 Issued in SC

Practice address

522 Main St N
Allendale, SC 29810-3720

Phone

(803) 584-2105

Fax

(803) 584-5757

NPI assigned

Sep 21, 2006

Last updated

Jan 2, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Craig S. Modzelewski DMD Inc.

  • General Practice Dentistry
  • Allendale, SC
  • NPI 1114163524
  NPD (past) Authorized official

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230854400000",
    "number": "1033218607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 MAIN ST N",
            "city": "ALLENDALE",
            "state": "SC",
            "postal_code": "298103720",
            "telephone_number": "803-584-2105",
            "fax_number": "803-584-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 MAIN ST N",
            "city": "ALLENDALE",
            "state": "SC",
            "postal_code": "298103720",
            "telephone_number": "803-584-2105",
            "fax_number": "803-584-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODZELEWSKI",
        "first_name": "CRAIG",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2009-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3892",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Hunter
• Icare Mobile Lab Services LLC
• Inspiring Growth Counseling Services
• Cindy L. Jackson, LPN
• Christy Jinks, MA
• New Life Care Service LLC
• Ohio Valley Physicians Inc (OVP Health)
• P&T Therapy Group LLC
• Paula Priester
• Cory Anthony Russell, LPCI

• General Practice Dentistry in Allendale, SC
• Providers in Allendale, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.