Marissa Ann Whitehead, DME

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7134 Issued in SC

Practice address

10 Medical Park
Palmetto Health Richland - Dental Educ
Columbia, SC 29203

Phone

(803) 434-6567

Fax

(803) 434-6299

NPI assigned

May 11, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

State licenses

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

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336694400000",
    "number": "1033478060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MEDICAL PARK",
            "address_2": "PALMETTO HEALTH RICHLAND - DENTAL EDUC",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-6567",
            "fax_number": "803-434-6299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MEDICAL PARK",
            "address_2": "PALMETTO HEALTH RICHLAND - DENTAL EDUC",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-6567",
            "fax_number": "803-434-6299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITEHEAD",
        "first_name": "MARISSA",
        "middle_name": "ANN",
        "credential": "DME",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-11",
        "last_updated": "2012-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "7134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Threasa Michele White
• Tiffany Renee White, FNP-C
• Amanda Lynn Whitehead, NP
• Christopher Ronnie Whitehead, LMSW
• Cristina Whitehead, FNP
• Aleigha Whiteside
• Crystal Renee Whitfield
• Michelle J Whitlow-Blanding, LPC
• Veronica Whitman, PT
• Evan Benjamin Whitmore

• General Practice Dentistry in Columbia, SC
• Providers in Columbia, 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 May 11, 2012; 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.