Victory Dental Center

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

4382 Issued in SC

Legal business name

VICTORY DENTAL CENTER

Practice address

9787 Charlotte Hwy Ste 201
Indian Land, SC 29707-5511

Phone

(803) 547-2280

Fax

(803) 547-4208

NPI assigned

Mar 19, 2015

Organization subpart

No

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

Authorized official

Name

Cedrick McDonaldNPI 1811197460

Title

Owner

Phone

(803) 547-2280

Specialties & licenses 1

Addresses

Practitioners 2

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

• Cedrick Brown McDonald, DDS

  • General Practice Dentistry
  • Indian Land, SC
  • NPI 1811197460
  NPD Authorized official
• Brandi Alexandria Magana, DMD

  • General Practice Dentistry
  • Indian Land, SC
  • NPI 1821510892
  NPD (past)

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

{
    "created_epoch": "1426723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1316331127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9787 CHARLOTTE HWY STE 201",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297075511",
            "telephone_number": "803-547-2280",
            "fax_number": "803-547-4208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9787 CHARLOTTE HWY STE 201",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297075511",
            "telephone_number": "803-547-2280",
            "fax_number": "803-547-4208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-19",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "CEDRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-547-2280"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "SC",
            "license": "4382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trueblue Management Group (Nine Mgmt)
• Mauricio Valencia, M.D.
• Ryan Valencic, D.C.
• Valerie L. Yaniszewski, DMD, PC (Smiles in the Sun)
• Emma Ventura
• Victory Dental Center, LLC
• Victory Dentistry for Kids
• Seth Patrick Vining, MD
• Lindsay Collins Waddell, PA-C
• Wal-Mart Stores East LP (Walmart Pharmacy 10-4237)

• Preferred Provider Organization in Indian Land, SC
• Providers in Indian Land, SC by specialty
• Preferred Provider Organization in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.