Legacy Prosthodontics LLC

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

Legal business name

LEGACY PROSTHODONTICS LLC

Practice address

3017 Newcastle Loop
Myrtle Beach, SC 29588-4502

Phone

(843) 215-4343

NPI assigned

Aug 18, 2025

Last updated

Aug 18, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Charles Johnson, DMDNPI 1164092441

Title

Owner-Dentist

Phone

(843) 215-4343

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Charles Johnson, DMD

  • General Practice Dentistry
  • Summerville, SC
  • NPI 1164092441
  NPD Authorized official
• Robert David Lazaroff, DDS

  • Prosthodontics
  • Myrtle Beach, SC
  • NPI 1942360482
  NPD (past)

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

{
    "created_epoch": "1755475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755475200000",
    "number": "1154208510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3017 NEWCASTLE LOOP",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295884502",
            "telephone_number": "843-215-4343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 NEWCASTLE LOOP",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295884502",
            "telephone_number": "843-215-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PROSTHODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-18",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER-DENTIST",
        "authorized_official_telephone_number": "843-215-4343",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Lee, FNP
• Melissa R Lee
• Ryan Lee, PA-C
• Sejong Lee, MD
• Wendy W Lee, MD
• Jonathan Leggett, D.O
• Lori Legrand, LCSW
• Brian Robert Lehman, DO
• Katherine Leninger
• Matthew Edward Lentz, D.C.

• Prosthodontics in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Prosthodontics in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; 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.