Southern Charm Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

SOUTHERN CHARM PEDIATRIC DENTISTRY

Practice address

2021 Bridgemill Rd.
Suite 108
Indian Land, SC 29707-2817

Phone

(562) 441-4757

NPI assigned

Sep 11, 2019

Last updated

Sep 11, 2019By 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

Angelica Wong, DDSNPI 1609920529

Title

Owner

Phone

(562) 441-4757

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.

• Angelica Pamela Wong, DDS

  • Pediatric Dentistry
  • Los Angeles, CA
  • NPI 1609920529
  NPD (past) Authorized official

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568160000000",
    "number": "1073162053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 WAYNEWOOD DR",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736907",
            "telephone_number": "562-441-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 BRIDGEMILL RD.",
            "address_2": "SUITE 108",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297072817",
            "telephone_number": "562-441-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CHARM PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-11",
        "last_updated": "2019-09-11",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "ANGELICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-441-4757",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theisha Marie Smith
• Zachariah Christian Smith
• Gregory Joseph Sokol, O.D.
• South Carolina CVS Pharmacy LLC (CVS Pharmacy #17932)
• South Carolina CVS Pharmacy, L.L.C. (CVS Pharmacy #05479)
• Julie Woods Staples, NP-C
• David Steinman
• Stevens Sight Specialists LLC (William V. Stevens, OD)
• Toni Rochelle Stevens, FNP
• William V Stevens, O.D.

• Pediatric Dentistry in Indian Land, SC
• Providers in Indian Land, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; 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.