Peyton McElveen Herndon

Primary specialty

DentistTaxonomy code 122300000X

License

9921 Issued in SC

Practice address

1 Winchester CT
Mauldin, SC 29662-2626

Phone

(864) 234-5515

Fax

(509) 357-8217

NPI assigned

Jun 23, 2021

Sex

Female

Sole proprietor

Yes

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

Practice roles

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.

• Family Dental Health of Mauldin LLC

  • General Practice Dentistry
  • Mauldin, SC
  • NPI 1841548930

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1063081081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MEMORIAL DRIVE EXT STE 400",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296511850",
            "telephone_number": "864-282-1935",
            "fax_number": "864-751-6387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WINCHESTER CT",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622626",
            "telephone_number": "864-234-5515",
            "fax_number": "509-357-8217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNDON",
        "first_name": "PEYTON",
        "middle_name": "MCELVEEN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Mauldin, SC
• Providers in Mauldin, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.