Active NPI
Nima Ghorbani Moghaddam
- General Practice Dentistry
- Lexington, SC
National Provider Identifier
1104741149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11559
- Practice address
- 203 N Lake Dr
Lexington, SC 29072-2833 - Phone
- (803) 520-3110
- NPI assigned
- Aug 11, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 11559 | SC | |
| General Practice Dentistry | 1223G0001X | 11559 | SC | Primary |
Addresses
Primary practice location
203 N Lake Dr
Lexington, SC 29072-2833
Mailing address
5800 Highlands Plaza Dr Apt 521
Saint Louis, MO 63110-1364
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1786406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788220800000",
"number": "1104741149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5800 HIGHLANDS PLAZA DR APT 521",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101364",
"fax_number": "864-762-1210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 N LAKE DR",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290722833",
"telephone_number": "803-520-3110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHORBANI MOGHADDAM",
"first_name": "NIMA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-08-11",
"last_updated": "2026-09-01",
"certification_date": "2026-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "SC",
"license": "11559",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "11559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.