Teeth DS Isle of Palms

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

TEETH DS ISLE OF PALMS

Practice address

15 21St Ave
Isle of Palms, SC 29451-2384

Phone

(843) 886-6461

NPI assigned

Oct 18, 2023

Organization subpart

Yes

Parent organization

TEETH DS ISLE OF PALMSAs reported in NPPES

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

Authorized official

Name

Luke Liszka, DMD

Title

Periodontist

Phone

(843) 886-6461

Specialties & licenses 2

Addresses

Other names 1

• Teeth DS IOP Endo Perio Doing business as

Tax ID family

Teeth DS Isle of Palms2 organizations share this tax ID, including this one

Part of

Teeth DS Isle of Palms

Other organizations with this tax ID 1

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

• Teeth DS Isle of Palms

  • Dental Clinic/Center
  • Isle of Palms, SC
  • NPI 1386244846
  NPD tax ID

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.

• Teeth DS Isle of Palms

  • Dental Clinic/Center
  • Isle of Palms, SC
  • NPI 1386244846
  NPPES parent name

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1144002791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 21ST AVE",
            "city": "ISLE OF PALMS",
            "state": "SC",
            "postal_code": "294512384",
            "telephone_number": "843-886-6461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 21ST AVE",
            "city": "ISLE OF PALMS",
            "state": "SC",
            "postal_code": "294512384",
            "telephone_number": "843-886-6461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEETH DS ISLE OF PALMS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TEETH DS ISLE OF PALMS",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A",
        "authorized_official_last_name": "LISZKA",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "843-886-6461",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teeth DS IOP Endo Perio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Glennis Randazzo, GLENNIS RANDAZZO
• William Rayburn, MD, MBA
• Caroline Rice
• Elissa Reilly Slater, BSN RN
• Caroline Sledden, RDN, LDN
• Teeth DS Isle of Palms
• The Island Doctor
• Tide Life Therapy LLC
• Richard George Wagner Jr., M.D.
• Lindsay Williams, ED.S.

• Endodontics in Isle of Palms, SC
• Providers in Isle of Palms, SC by specialty
• Endodontics in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.