NPIMap

Organization Active NPI

Florence Smiles Youth Dentistry, LLC

  • General Practice Dentistry
  • Florence, SC
National Provider Identifier
1235109042
Registry record updated Jul 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FLORENCE SMILES YOUTH DENTISTRY, LLC
Practice address
943 S Irby St
Florence, SC 29501-5217
Phone
(843) 673-0075
Fax
(843) 673-0024
NPI assigned
Jan 24, 2006
Last updated
Jul 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2014

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

Authorized official

Name
Ms. Jenell Stump
Title
Specialist
Phone
(615) 750-0343

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

943 S Irby St
Florence, SC 29501-5217

Mailing address

16 Arcade Unit 198747
Nashville, TN 37219-1994
Phone (615) 750-0343

Other identifiers 1

IdentifierTypeStateIssuer
ZA9556MedicaidSC

National Provider Directory

National Provider Directory

Locations

943 S Irby St
Florence, SC 29501
Phone (843) 673-0075

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1235109042",
    "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": "943 S IRBY ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295015217",
            "telephone_number": "843-673-0075",
            "fax_number": "843-673-0024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORENCE SMILES YOUTH DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-24",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "SPECIALIST",
        "authorized_official_telephone_number": "615-750-0343",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9556",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

  • 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.