NPIMap

Organization Active NPI

Dental Professionals of South Carolina, PC

Doing business as Smiles at Carolina Forest

  • General Practice Dentistry
  • Myrtle Beach, SC
National Provider Identifier
1053706747
Registry record updated Mar 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF SOUTH CAROLINA, PC
Doing business as
Smiles at Carolina Forest
Practice address
100 Debo Dr Unit 110
Myrtle Beach, SC 29579-4921
Phone
(844) 514-4569
NPI assigned
Mar 31, 2015
Last updated
Mar 31, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF SOUTH CAROLINA, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 31, 2015

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

Authorized official

Name
Heather Pruemer
Title
Credentialing
Phone
(217) 540-8434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

100 Debo Dr Unit 110
Myrtle Beach, SC 29579-4921

Mailing address

100 Debo Dr Unit 110
Myrtle Beach, SC 29579-4921

Other names 1

  • Smiles at Carolina Forest Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of SC PC74 organizations share this tax ID, including this one
Part of
Dental Professionals of SC PC

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Locations

100 Debo Dr
Unit 110
Myrtle Beach, SC 29579
Phone (843) 236-8848

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427760000000",
    "number": "1053706747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 DEBO DR UNIT 110",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295794921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DEBO DR UNIT 110",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295794921",
            "telephone_number": "844-514-4569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, PC",
        "enumeration_date": "2015-03-31",
        "last_updated": "2015-03-31",
        "status": "A",
        "authorized_official_last_name": "PRUEMER",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "217-540-8434"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smiles at Carolina Forest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2015; 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.