NPIMap

Organization Active NPI

Peninsula Cosmetic and Family Dentistry, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Charleston, SC
National Provider Identifier
1255938320
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PENINSULA COSMETIC AND FAMILY DENTISTRY, INC.
Practice address
538 Savannah Hwy
Charleston, SC 29407-7210
Phone
(843) 722-1676
NPI assigned
Oct 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Authorized official

Name
Dr. James Bradley Wisner, DMDNPI 1669583647
Title
Owner/Dentist
Phone
(843) 722-1676

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

538 Savannah Hwy
Charleston, SC 29407-7210

Mailing address

538 Savannah Hwy
Charleston, SC 29407-7210
Phone (843) 722-1676

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL office@peninsuladentistry.net

National Provider Directory

National Provider Directory

Locations

538 Savannah Hwy
Charleston, SC 29407
Phone (843) 722-1676

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1255938320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 SAVANNAH HWY",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077210",
            "telephone_number": "843-722-1676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 SAVANNAH HWY",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077210",
            "telephone_number": "843-722-1676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA COSMETIC AND FAMILY DENTISTRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-02",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "WISNER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "843-722-1676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "office@peninsuladentistry.net",
            "affiliation": "N",
            "address_1": "538 Savannah Hwy",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294077210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.