NPIMap

Organization Active NPI

Kool Smiles SC-2, PC

Doing business as Kool Smiles

  • General Practice Dentistry
  • Orangeburg, SC
National Provider Identifier
1063708410
Registry record updated Nov 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KOOL SMILES SC-2, PC
Doing business as
Kool Smiles
Practice address
1350 Grove Park Dr
Orangeburg, SC 29115-2455
Phone
(770) 916-9000
NPI assigned
Jun 23, 2011
Last updated
Nov 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2014

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

Authorized official

Name
David Vieth, DDS
Title
President
Phone
(770) 916-5028

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X NU
General Practice Dentistry 1223G0001X NU Primary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU

Addresses

Primary practice location

1350 Grove Park Dr
Orangeburg, SC 29115-2455

Mailing address

1090 Northchase Pkwy SE Ste 150
Marietta, GA 30067-6407

Other names 1

  • Kool Smiles Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kool Smiles6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1350 Grove Park Dr
Orangeburg, SC 29115
Phone (706) 799-5174

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1063708410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 GROVE PARK DR",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291152455",
            "telephone_number": "770-916-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOL SMILES SC-2, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-23",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "VIETH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-916-5028",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kool Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orangeburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; 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.