NPIMap

Organization Active NPI

John G McRoberts DMD PA

  • General Practice Dentistry
  • Seneca, SC
National Provider Identifier
1144234063
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3718SC Issued in SC
Legal business name
JOHN G MCROBERTS DMD PA
Practice address
875 Old Clemson Hwy
Seneca, SC 29672-8060
Phone
(864) 654-5733
Fax
(864) 654-1117
NPI assigned
Jul 28, 2006
Last updated
Jul 14, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
JOHN G MCROBERTS DMD PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Authorized official

Name
Connie Hix Black
Title
Office Manager
Phone
(864) 654-5733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3718SC SC Primary

Addresses

Primary practice location

875 Old Clemson Hwy
Seneca, SC 29672-8060

Mailing address

PO Box 349
Clemson, SC 29633
Phone (864) 654-5733

Other identifiers 8

IdentifierTypeStateIssuer
1223G0001XOtherSCPROVIDER TAXONOMIES
1738OtherSCLIC# TN
122300000XOtherSCPROVIDER TAXONOMIES
4110OtherSCSC LIC #
ZA9517MedicaidSC
ZX1738MedicaidSC
3718OtherSCSC LIC #
ZX3718MedicaidSC

Other names 1

  • Clemson Family Dentistry Other name

National Provider Directory

National Provider Directory
Part of
John G McRoberts DMD PA

Locations

875 Old Clemson Hwy
Seneca, SC 29672
Phone (864) 654-5733

Practitioners & affiliated clinicians

Practitioners 6

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": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1144234063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 349",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "29633",
            "telephone_number": "864-654-5733",
            "fax_number": "864-654-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 OLD CLEMSON HWY",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296728060",
            "telephone_number": "864-654-5733",
            "fax_number": "864-654-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN G MCROBERTS DMD PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOHN G MCROBERTS DMD PA",
        "enumeration_date": "2006-07-28",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "HIX",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "864-654-5733"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3718SC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER TAXONOMIES",
            "identifier": "1223G0001X",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC# TN",
            "identifier": "1738",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER TAXONOMIES",
            "identifier": "122300000X",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC LIC #",
            "identifier": "4110",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9517",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX1738",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC LIC #",
            "identifier": "3718",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3718",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clemson Family Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Seneca, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.