Charleston Youth Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CHARLESTON YOUTH DENTISTRY, LLC

Practice address

6035A Rivers Ave
North Charleston, SC 29406-4924

Phone

(843) 572-9909

Fax

(843) 572-9901

NPI assigned

May 3, 2006

Last updated

Jul 9, 2014By 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

Mrs. Jenell Stump

Title

Manager, Licensing & Credentialing

Phone

(615) 750-0343

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Charleston Youth Dentistry LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Children's Dental Clinic of Charleston, LLC

  dba Children's Wellness Clinic

  • Nurse Practitioner
  • North Charleston, SC
  • NPI 1730467978
  NPD tax ID

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1215995501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ARCADE UNIT 198747",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372191994",
            "telephone_number": "615-750-0343",
            "fax_number": "615-986-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6035A RIVERS AVE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294064924",
            "telephone_number": "843-572-9909",
            "fax_number": "843-572-9901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON YOUTH DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "MANAGER, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "615-750-0343",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9597",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charleston Surgical Consultants, LLC (The Charleston Sinus Center/Russell Facial Plastic Surgery)
• Charleston VA Cmop
• Charleston Vamc
• Charleston Vamc
• Charleston Vamc
• Kenzie Jane Chase, RN
• Farhana Chaudhary, M.D.
• Carol Cheaz, PHARMD
• Lauren Cherry
• Carly Jaine Chevrette, BS ADC-IP

• General Practice Dentistry in North Charleston, SC
• Providers in North Charleston, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.