Active NPI
Holly Mangum, DMD
- Dentist
- Loris, SC
National Provider Identifier
1144483728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4487
- Practice address
- 4004 Bayboro St
Loris, SC 29569-2867 - Phone
- (843) 756-2273
- Fax
- (843) 756-0242
- NPI assigned
- Jul 3, 2008
- Last updated
- Jul 3, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4487 | SC | Primary |
Addresses
Primary practice location
4004 Bayboro St
Loris, SC 29569-2867
Mailing address
4004 Bayboro St
Loris, SC 29569-2867
Phone (843) 756-2273
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4487 | SC | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DS Dental, LLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215043200000",
"number": "1144483728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4004 BAYBORO ST",
"city": "LORIS",
"state": "SC",
"postal_code": "295692867",
"telephone_number": "843-756-2273",
"fax_number": "843-756-0242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4004 BAYBORO ST",
"city": "LORIS",
"state": "SC",
"postal_code": "295692867",
"telephone_number": "843-756-2273",
"fax_number": "843-756-0242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGUM",
"first_name": "HOLLY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-03",
"last_updated": "2008-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "4487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loris, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.