Trident Dental Associates, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

TRIDENT DENTAL ASSOCIATES, LLC

Practice address

9228 Medical Plaza Dr
Charleston, SC 29406-9125

Phone

(843) 574-5693

Fax

(843) 764-4512

NPI assigned

Sep 28, 2021

Organization subpart

No

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

Authorized official

Name

William Tederick Johnson

Title

Group Vice President/Ao

Phone

(615) 372-3375

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Betsy Kay Davis, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Charleston, SC
  • NPI 1518983857

  SC

  Medicare reassignment Care Compare group NPD
• Michelle Kathryn Ruse, DDS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Charleston, SC
  • NPI 1205583481

  Oral and Maxillofacial Surgery, SC

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1053083154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274692",
            "telephone_number": "615-373-7406",
            "fax_number": "866-346-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9228 MEDICAL PLAZA DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294069125",
            "telephone_number": "843-574-5693",
            "fax_number": "843-764-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT DENTAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-28",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "TEDERICK",
        "authorized_official_title_or_position": "GROUP VICE PRESIDENT/AO",
        "authorized_official_telephone_number": "615-372-3375"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tricounty Surgical Associates, PA
• Trident Ambulatory Surgery Center, L.P.
• Trident Anesthesia Group, LLC
• Trident Anesthesia Group, LLC
• Trident Behavioral Health Services LLC
• Trident Dental Partners LLC
• Trident Dental Specialty Partners
• Trident Dermatology, PA
• Trident Emergency Physicians LLC
• Trident General Dentistry PA

• Oral and Maxillofacial Surgery (Dentist) in Charleston, SC
• Providers in Charleston, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.