NPIMap

Organization Active NPI

R.E. Offutt, DDS, Ms and B.L. Cockerham DDS, MSP, PLLC

Doing business as Fort Mill Periodontics & Implant Dentistry

  • Periodontics
  • Fort Mill, SC
National Provider Identifier
1275016263
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
R.E. OFFUTT, DDS, MS AND B.L. COCKERHAM DDS, MSP, PLLC
Doing business as
Fort Mill Periodontics & Implant Dentistry
Practice address
929 Market St
Fort Mill, SC 29708
Phone
(803) 547-0304
Fax
(704) 366-2639
NPI assigned
Sep 14, 2018
Last updated
Sep 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

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

Authorized official

Name
Richard Offutt, DDSNPI 1356391122
Title
Owner
Phone
(704) 366-2774

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

929 Market St
Fort Mill, SC 29708

Mailing address

6719 Fairview Road
Charlotte, NC 28210
Phone (704) 366-2774

Other names 1

  • Fort Mill Periodontics & Implant Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

929 Market St
Fort Mill, SC 29708
Phone (803) 547-0304

Practitioners & affiliated clinicians

Practitioners 2

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": "1536883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537228800000",
    "number": "1275016263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6719 FAIRVIEW ROAD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28210",
            "telephone_number": "704-366-2774",
            "fax_number": "704-366-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 MARKET ST",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "29708",
            "telephone_number": "803-547-0304",
            "fax_number": "704-366-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R.E. OFFUTT, DDS, MS AND B.L. COCKERHAM DDS, MSP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-14",
        "last_updated": "2018-09-18",
        "status": "A",
        "authorized_official_last_name": "OFFUTT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-366-2774",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Mill Periodontics & Implant Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Mill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; 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.