NPIMap

Organization Active NPI

Dental Professional of South Carolina, P.C.

Doing business as Farrow Parkway Dental Care

  • General Practice Dentistry
  • Myrtle Beach, SC
National Provider Identifier
1104467224
Registry record updated Dec 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.
Doing business as
Farrow Parkway Dental Care
Practice address
2749 Agnes LN
Myrtle Beach, SC 29577-2029
Phone
(843) 213-6653
Fax
(843) 492-5993
NPI assigned
Sep 30, 2019
Last updated
Dec 12, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 12, 2019

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

Authorized official

Name
Jessica Britt
Title
Credentialing Coordinator
Phone
(217) 540-5100

Specialties & licenses 1

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

Addresses

Primary practice location

2749 Agnes LN
Myrtle Beach, SC 29577-2029

Mailing address

2749 Agnes LN
Myrtle Beach, SC 29577-2029
Phone (843) 491-4378

Other names 1

  • Farrow Parkway Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professional of South Carolina PC74 organizations share this tax ID, including this one
Part of
Dental Professional of South Carolina PC

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Locations

2749 Agnes Ln
Myrtle Beach, SC 29577
Phone (843) 213-6653

Practitioners & affiliated clinicians

Practitioners 3

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": "1569801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576108800000",
    "number": "1104467224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2749 AGNES LN",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295772029",
            "telephone_number": "843-491-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2749 AGNES LN",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295772029",
            "telephone_number": "843-213-6653",
            "fax_number": "843-492-5993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.",
        "enumeration_date": "2019-09-30",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A",
        "authorized_official_last_name": "BRITT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Farrow Parkway Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Farrow Parkway Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.