Fleetwood Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3264 Issued in SC

Legal business name

FLEETWOOD DENTAL

Practice address

105 Fleetwood Dr
Easley, SC 29640-2019

Phone

(864) 855-2788

Fax

(864) 855-2789

NPI assigned

Mar 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Willis Ely Hawkins III, DMD

Title

Owner

Phone

(864) 855-2788

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073647889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 FLEETWOOD DR",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296402019",
            "telephone_number": "864-855-2788",
            "fax_number": "864-855-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 FLEETWOOD DR",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296402019",
            "telephone_number": "864-855-2788",
            "fax_number": "864-855-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLEETWOOD DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "WILLIS",
        "authorized_official_middle_name": "ELY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-855-2788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Firstchoice Healthcare PC
• Brian Matthew Fisher, MD
• Elizabeth Fisher
• Gary Fisher
• Stephanie Fisher, PA
• Fleetwood Internal Medicine PA
• Fleetwood Rehabilitation and Healthcare Center, LLC
• Fleetwood Square Dental, LLC
• Elizabeth Alice Floyd, RN
• Foothills Bariatric and Wellness Center

• General Practice Dentistry in Easley, SC
• Providers in Easley, 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 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.