NPIMap

Organization Active NPI

Dental Associates of Summerville, LLC

  • General Practice Dentistry
  • Summerville, SC
National Provider Identifier
1063635753
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL ASSOCIATES OF SUMMERVILLE, LLC
Practice address
209 W 5TH North St
Summerville, SC 29483-6511
Phone
(843) 873-3706
NPI assigned
Apr 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Melissa Grooms
Title
Administrative Assistant
Phone
(843) 873-3706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X SC Primary

Addresses

Primary practice location

209 W 5TH North St
Summerville, SC 29483-6511

Mailing address

209 W 5TH North St
Summerville, SC 29483-6511

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063635753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 W 5TH NORTH ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294836511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W 5TH NORTH ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294836511",
            "telephone_number": "843-873-3706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL ASSOCIATES OF SUMMERVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GROOMS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "843-873-3706"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.