NPIMap

Organization Active NPI

Bella Vista Family Dental at Five Forks

  • General Practice Dentistry
  • Simpsonville, SC
National Provider Identifier
1073016937
Registry record updated Mar 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4377 Issued in SC
Legal business name
BELLA VISTA FAMILY DENTAL AT FIVE FORKS
Practice address
2311 Woodruff Rd
Simpsonville, SC 29681-5442
Phone
(864) 501-9800
NPI assigned
Mar 16, 2018
Last updated
Mar 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2018

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

Authorized official

Name
Dr. John Kennedy Jr., DMDNPI 1184808396
Title
Owner
Phone
(864) 501-0070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4377 SC
General Practice Dentistry 1223G0001X 4377 SC Primary

Addresses

Primary practice location

2311 Woodruff Rd
Simpsonville, SC 29681-5442

Mailing address

PO Box 31625
Greenville, SC 29608-1625

National Provider Directory

National Provider Directory

Locations

2311 Woodruff Rd
Simpsonville, SC 29681
Phone (864) 501-9800

Practitioners & affiliated clinicians

Practitioners 4

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": "1521158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521158400000",
    "number": "1073016937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31625",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296081625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 WOODRUFF RD",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296815442",
            "telephone_number": "864-501-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLA VISTA FAMILY DENTAL AT FIVE FORKS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-16",
        "last_updated": "2018-03-16",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-501-0070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "4377",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simpsonville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.