NPIMap

Organization Active NPI

Palmetto Family and Cosmetic Dentistry IV

  • General Practice Dentistry
  • Sumter, SC
National Provider Identifier
1124805254
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PALMETTO FAMILY AND COSMETIC DENTISTRY IV
Practice address
1210 Wilson Hall Rd
Sumter, SC 29150-1889
Phone
(803) 877-6703
NPI assigned
Sep 12, 2023
Organization subpart
Yes
Parent organization
PALMETTO FAMILY AND COSMETIC DENTISTRY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
Evelyn Horne
Title
Ceo
Phone
(803) 877-6703

Specialties & licenses 1

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

Addresses

Primary practice location

1210 Wilson Hall Rd
Sumter, SC 29150-1889

Mailing address

1210 Wilson Hall Rd
Sumter, SC 29150-1889
Phone (803) 877-6703

Other names 1

  • Sumter Dental Surgery Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Palmetto Family and Cosmetic Dentistry LLC4 organizations share this tax ID, including this one
Part of
Palmetto Family and Cosmetic Dentistry LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1694476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1124805254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 WILSON HALL RD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291501889",
            "telephone_number": "803-877-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 WILSON HALL RD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291501889",
            "telephone_number": "803-877-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO FAMILY AND COSMETIC DENTISTRY IV",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALMETTO FAMILY AND COSMETIC DENTISTRY LLC",
        "enumeration_date": "2023-09-12",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "HORNE",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-877-6703"
    },
    "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": "Sumter Dental Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sumter, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; 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.