L Jarrette Burckhalter IV, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

SC2095 Issued in SC

Practice address

1643 Carolina Avenue
Orangeburg, SC 29115

Phone

(803) 534-7525

Fax

(803) 534-7526

NPI assigned

Dec 5, 2006

Last updated

Jul 8, 2007By 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

State licenses

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043378870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1643 CAROLINA AVENUE",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "29115",
            "telephone_number": "803-534-7525",
            "fax_number": "803-534-7526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1643 CAROLINA AVENUE",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "29115",
            "telephone_number": "803-534-7525",
            "fax_number": "803-534-7526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURCKHALTER",
        "first_name": "L",
        "middle_name": "JARRETTE",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "SC2095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "341798",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randolph Charles Bryson, D.M.D.
• Zachary Michael Buchanan, DO
• Jerrold M Buckaloo, MD
• Carey Alan Bunch, CPO
• Jennifer S Bunch, OTR/L
• Bridgett Shavonne Burnett, LPN
• Maia Burnett, RD, LD
• Alex Burshtynsky, DPT
• Kizmit Busby Felder
• Tammye Janene Busby, MSN, APRN, FNP-BC

• General Practice Dentistry in Orangeburg, SC
• Providers in Orangeburg, 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 Jul 8, 2007; 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.