South Side Dental Care LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTH SIDE DENTAL CARE LLC

Practice address

4808 Derry St
Harrisburg, PA 17111-3440

Phone

(717) 564-9250

Fax

(717) 564-3089

NPI assigned

May 1, 2020

Organization subpart

No

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

Authorized official

Name

Huong T Bui, DDS

Title

Owner

Phone

(717) 564-9250

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Karl D Otto, DDS

  • General Practice Dentistry
  • Harrisburg, PA
  • NPI 1326267527
  NPD (past)

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

{
    "created_epoch": "1588291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588291200000",
    "number": "1265053144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4808 DERRY ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171113440",
            "telephone_number": "717-564-9250",
            "fax_number": "717-564-3089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4808 DERRY ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171113440",
            "telephone_number": "717-564-9250",
            "fax_number": "717-564-3089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SIDE DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-01",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A",
        "authorized_official_last_name": "BUI",
        "authorized_official_first_name": "HUONG",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "717-564-9250",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soul Restored Transit LLC
• Sound Community Solutions
• Sound Community Solutions
• South Central Emergency Medical Services, Inc.
• South Side Dental Care LLC
• Ronald Thomas Sowal, D.M.D.
• John Spagnola, R.PH.
• Stacey Michelle Spahr, CRNP
• Haley Spangler, DPT
• Michael Scot Spangler, D.O.

• General Practice Dentistry in Harrisburg, PA
• Providers in Harrisburg, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.