Ancient Mariner, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2905 Issued in SC

Legal business name

ANCIENT MARINER, LLC

Doing business as

Children and Adult Dental Group

Practice address

1118 Greenlawn Dr
Columbia, SC 29209-2606

Phone

(803) 807-2140

NPI assigned

Apr 7, 2014

Last updated

Oct 27, 2015By 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

Tonia Patterson

Title

Office Administrator

Phone

(803) 600-7211

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Children and Adult Dental Group Doing business as

Locations

Practitioners 1

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.

• Telah Alasia-Marie Wingate, DMD, MBA

  • General Practice Dentistry
  • Columbia, SC
  • NPI 1164266771
  NPD (past)

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

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445904000000",
    "number": "1225456247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7457 PATTERSON RD STE 107",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292090710",
            "telephone_number": "803-807-2140",
            "fax_number": "803-807-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 GREENLAWN DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292092606",
            "telephone_number": "803-807-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANCIENT MARINER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-07",
        "last_updated": "2015-10-27",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "TONIA",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "803-600-7211"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "2905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z29050",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children and Adult Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Joseph Amrol, M.D.
• Jennifer Gregory Amrol, MD
• Amsurg Columbia Anesthesia LLC
• Chandra Ancell, RBT
• Anchored in Hope Counseling Services, LLC
• Lauren Frances Ancona, M.D.
• Erica Anders
• Anderson Home Health Care, LLC (Anderson Home Care)
• Celia Anderson Jackson
• Alicia Anderson-Brown

• Dental Clinic/Center in Columbia, SC
• Providers in Columbia, SC by specialty
• Dental Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; 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.