Longboard Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LONGBOARD DENTAL LLC

Practice address

405 Faison Road
Suire A3
Mt Pleasant, SC 29466

Phone

(843) 654-1373

Fax

(843) 654-1374

NPI assigned

Nov 14, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Ellen Paulisick Wolf, DDS, FAGDNPI 1407138795

Title

Dentist

Phone

(843) 654-1373

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.

• Ellen Paulisick Wolf, D.D.S, FAGD

  • Dentist
  • Mt Pleasant, SC
  • NPI 1407138795
  NPD (past) Authorized official

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

{
    "created_epoch": "1668384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1134837503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 FAISON ROAD",
            "address_2": "SUIRE A3",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "29466",
            "telephone_number": "843-654-1373",
            "fax_number": "843-654-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 FAISON ROAD",
            "address_2": "SUIRE A3",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "29466",
            "telephone_number": "843-654-1373",
            "fax_number": "843-654-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGBOARD DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-14",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-09",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "PAULISICK",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "843-654-1373",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, FAGD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Long Point Family Chiropractic, LLC
• Long Point Pharmacy
• Edward R Long, PT
• Eric Lee Long, MD
• Joshua Christian Long, PT
• Longboard Recovery
• Olin Iman Longino, PA-C
• Sarah Ashley Lorick, PA-C, ATC
• Lorimax, LLC
• Love of Language

• Dental Clinic/Center in Mt Pleasant, SC
• Providers in Mt Pleasant, SC by specialty
• Dental Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; 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.