Clinton Dental Care LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4208 Issued in SC

Legal business name

CLINTON DENTAL CARE LLC

Practice address

1208 Springdale Dr
Clinton, SC 29325-7225

Phone

(864) 833-5400

Fax

(864) 833-5417

NPI assigned

Jun 5, 2007

Last updated

Mar 29, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kristin Rowland Derrick, DMDNPI 1114088556

Title

Dentist

Phone

(864) 833-5400

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Kristin Rowland Derrick, DMD

  • General Practice Dentistry
  • Clinton, SC
  • NPI 1114088556
  NPD (past) Authorized official

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522281600000",
    "number": "1063614469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 SPRINGDALE DR.",
            "address_2": "PO BOX 837",
            "city": "CLINTON",
            "state": "SC",
            "postal_code": "29325",
            "telephone_number": "864-833-5400",
            "fax_number": "864-833-5417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 SPRINGDALE DR",
            "city": "CLINTON",
            "state": "SC",
            "postal_code": "293257225",
            "telephone_number": "864-833-5400",
            "fax_number": "864-833-5417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINTON DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2018-03-29",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "ROWLAND",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "864-833-5400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Preeti Luthra Chhatwal II, R.P.T.
• Julia Olson Childers, DMD
• Bethany Jo Davis Christie, BCBA
• Clear Skye Medical Holdings, LLC
• Clinton Crack House
• Clinton Dialysis Clinic LLC
• Clinton Discount Pharmacy LLC (Clinton Discount Pharmacy)
• Clinton Family Practice, Inc.
• Shelley Colip
• Sarah Kathryn Cook

• General Practice Dentistry in Clinton, SC
• Providers in Clinton, 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 Mar 29, 2018; 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.