Crystal H Isenhower, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3529 Issued in SC

Practice address

107 Waccamaw Medical Park Dr
Conway, SC 29526-8902

Phone

(843) 234-3110

Fax

(843) 234-3109

NPI assigned

Jan 28, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Crystal Isenhower, DMD, LLC

  • Dentist
  • Conway, SC
  • NPI 1629184171
  NPD (past)

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201478400000",
    "number": "1336326727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WACCAMAW MEDICAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268902",
            "telephone_number": "843-234-3110",
            "fax_number": "843-234-3109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WACCAMAW MEDICAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268902",
            "telephone_number": "843-234-3110",
            "fax_number": "843-234-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISENHOWER",
        "first_name": "CRYSTAL",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-28",
        "last_updated": "2008-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9675",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Conway, SC
• Providers in Conway, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.