Active NPI
Jesse Beasley Knowlton, DMD
- General Practice Dentistry
- Sumter, SC
National Provider Identifier
1215615638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10584
- Practice address
- 2590 Tahoe Dr
Sumter, SC 29150-1860 - Phone
- (803) 877-6703
- NPI assigned
- Jul 6, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10584 | SC | Primary |
Addresses
Primary practice location
2590 Tahoe Dr
Sumter, SC 29150-1860
Mailing address
2590 Tahoe Dr
Sumter, SC 29150-1860
Phone (803) 877-6703
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 |
|---|---|---|---|
| 10584 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688601600000",
"number": "1215615638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2590 TAHOE DR",
"city": "SUMTER",
"state": "SC",
"postal_code": "291501860",
"telephone_number": "803-877-6703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2590 TAHOE DR",
"city": "SUMTER",
"state": "SC",
"postal_code": "291501860",
"telephone_number": "803-877-6703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNOWLTON",
"first_name": "JESSE",
"middle_name": "BEASLEY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-06",
"last_updated": "2023-07-06",
"certification_date": "2023-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "10584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sumter, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.