Southern Oak Dental Greenville, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SOUTHERN OAK DENTAL GREENVILLE, LLC

Practice address

101 Verdae Blvd Ste 560
Greenville, SC 29607-3834

Phone

(864) 558-7155

Fax

(864) 900-2511

NPI assigned

Oct 7, 2022

Last updated

Oct 7, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sabrina Crumby

Title

Credentialing

Phone

(864) 558-7155

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1665100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665100800000",
    "number": "1053036434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 VERDAE BLVD STE 560",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296073834",
            "telephone_number": "864-558-7155",
            "fax_number": "864-900-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 VERDAE BLVD STE 560",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296073834",
            "telephone_number": "864-558-7155",
            "fax_number": "864-900-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OAK DENTAL GREENVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-07",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A",
        "authorized_official_last_name": "CRUMBY",
        "authorized_official_first_name": "SABRINA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "864-558-7155"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Greenville, SC
• Providers in Greenville, SC by specialty
• Dental Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; 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.