Elizabeth Alexander, D.M.D. – Dentist

Key facts

NPI: 1154761989
Entity type: Individual (NPI type 1)
Primary specialty: Dentist 122300000X
License: 9246 (SC)
Practice address: 485 Tom Hall St Ste 106
Fort Mill, SC 29715-2353
Phone: (803) 485-9333
NPI assigned: Jun 25, 2013
Sex: Female
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Core Dentistry LLC Dental Clinic/Center · Fort Mill, SC · NPI 1770138505

NPD Authorized official
Ascent Dental Care LLC General Practice Dentistry · East Longmeadow, MA · NPI 1114492345

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20151102001285	MA	Order and Referring Only - Dentist Practitioner - Dentist	7012227127

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
DN1856296	MA	MD	Dentist
11713	NC	MD	Dentist
9246	SC	MD	Dentist

Practice roles

Organization	Specialty	Status	New patients
Core Dentistry LLC		Current since Aug 2, 2020	Accepting new patients
Ascent Dental Care LLC		Past since Jul 28, 2019	Accepting new patients

Locations

485 Tom Hall St
Ste 106
Fort Mill, SC 29715
Phone (803) 485-9333

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	11713	NC
Dentist	122300000X	DN1856296	MA
Dentist	122300000X	9246	SC	Yes

Addresses

Primary practice location

485 Tom Hall St Ste 106
Fort Mill, SC 29715-2353

Mailing address

485 Tom Hall St Ste 106
Fort Mill, SC 29715-2353

Other practice location 1

250 N Main St
East Longmeadow, MA 01028-1834
Phone (413) 224-1493

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 8, 2023.

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678233600000",
    "number": "1154761989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 TOM HALL ST STE 106",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297152353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 TOM HALL ST STE 106",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297152353",
            "telephone_number": "803-485-9333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 N Main St",
            "address_purpose": "LOCATION",
            "city": "East Longmeadow",
            "state": "MA",
            "postal_code": "010281834",
            "country_code": "US",
            "telephone_number": "413-224-1493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALEXANDER",
        "first_name": "ELIZABETH",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-25",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "11713",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1856296",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "9246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Mill, SC

All providers in Fort Mill, SC · Dentist in South Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.