Active NPI
John Swygert Timmerman Jr., DMD
- General Practice Dentistry
- Hanahan, SC
National Provider Identifier
1053750364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2897
- Practice address
- 1024 Dennis Dr
Hanahan, SC 29410-2222 - Phone
- (843) 747-0645
- NPI assigned
- Jun 19, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2897 | SC | Primary |
Addresses
Primary practice location
1024 Dennis Dr
Hanahan, SC 29410-2222
Mailing address
1024 Dennis Dr
Hanahan, SC 29410-2222
Phone (843) 747-0645
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2897 | SC | MD | Physical Therapy Assistant |
Interoperability endpoints
- john.timmerman.p1@direct.scdc.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371600000000",
"number": "1053750364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1024 DENNIS DR",
"city": "HANAHAN",
"state": "SC",
"postal_code": "294102222",
"telephone_number": "843-747-0645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1024 DENNIS DR",
"city": "HANAHAN",
"state": "SC",
"postal_code": "294102222",
"telephone_number": "843-747-0645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIMMERMAN",
"first_name": "JOHN",
"middle_name": "SWYGERT",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-19",
"last_updated": "2013-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "2897",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hanahan, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.