NPIMap

Organization Active NPI

Liner, Ward & Shobe DDS, PA

Doing business as Southern Dental Associates

  • Dentist
  • Wilkesboro, NC
National Provider Identifier
1053442210
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
LINER, WARD & SHOBE DDS, PA
Doing business as
Southern Dental Associates
Practice address
1690 River St
Wilkesboro, NC 28697-7630
Phone
(336) 838-9400
Fax
(336) 838-1872
NPI assigned
Mar 8, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
LINER, WARD & SHOBE DDS, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dacia K Eilert-Holcomb
Title
Office Manager
Phone
(336) 945-5555

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary
Pediatric Dentistry 1223P0221X NC

Addresses

Primary practice location

1690 River St
Wilkesboro, NC 28697-7630

Mailing address

1690 River St
Wilkesboro, NC 28697-7630
Phone (336) 838-9400

Other names 1

  • Southern Dental Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Liner Ward Shobe DDS PA3 organizations share this tax ID, including this one
Part of
Liner Ward Shobe DDS PA

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053442210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1690 RIVER ST",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286977630",
            "telephone_number": "336-838-9400",
            "fax_number": "336-838-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 RIVER ST",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286977630",
            "telephone_number": "336-838-9400",
            "fax_number": "336-838-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINER, WARD & SHOBE DDS, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LINER, WARD & SHOBE DDS, PA",
        "enumeration_date": "2007-03-08",
        "last_updated": "2022-07-21",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "EILERT-HOLCOMB",
        "authorized_official_first_name": "DACIA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "336-945-5555"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilkesboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.