Logan B Ebersold, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4618 Issued in SC

Practice address

200 N Dobys Bridge Rd Ste 108
Fort Mill, SC 29715-2084

Phone

(803) 396-5888

Fax

(803) 396-5896

NPI assigned

Jul 2, 2009

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Catawba River Dentistry, LLC

  • General Practice Dentistry
  • Fort Mill, SC
  • NPI 1255113932
  NPD
• Carolina Professional Dentistry,LLC

  • General Practice Dentistry
  • Fort Mill, SC
  • NPI 1649451410
  NPD (past)
• Dr. Marcus E. Trombley, DDS-LLC

  • Dental Clinic/Center
  • Rock Hill, SC
  • NPI 1659500189
  NPD (past)

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

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1053540708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N DOBYS BRIDGE RD STE 108",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297152084",
            "telephone_number": "803-396-5888",
            "fax_number": "803-396-5893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N DOBYS BRIDGE RD STE 108",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297152084",
            "telephone_number": "803-396-5888",
            "fax_number": "803-396-5896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERSOLD",
        "first_name": "LOGAN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-02",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Richard Dutson, O.D.
• Hilary Ann Dwyer, LPC-A
• Gina Dyer-Goss, MSN-FN
• Dynamic Physical Therapy & Rehabilitation
• Jean Ellen Earhart, LCSW
• Edge Solutions Group, LLC Dba Americare Fort Mill
• Trisha Edge, MBA
• Edgewater Medical Center
• Edgewater Urgent Care
• Torian Edwards, RBT

• General Practice Dentistry in Fort Mill, SC
• Providers in Fort Mill, 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 20, 2021; 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.