NPIMap

Organization Active NPI

Southern Oak Dental, LLC

  • General Practice Dentistry
  • Sumter, SC
National Provider Identifier
1336761097
Registry record updated May 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SOUTHERN OAK DENTAL, LLC
Practice address
1322 Broad St Unit 90
Sumter, SC 29150-1984
Phone
(912) 856-9698
NPI assigned
May 15, 2020
Last updated
May 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2020

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

Authorized official

Name
Frank Gong
Title
Owner
Phone
(206) 371-2516

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

1322 Broad St Unit 90
Sumter, SC 29150-1984

Mailing address

4921 Centre Pointe Dr Ste 201
North Charleston, SC 29418-6997
Phone (912) 856-9698

Other names 1

  • Dental Home EB5 VII Other name

National Provider Directory

National Provider Directory
Tax ID family
Southern Oak Dental LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1322 Broad St
Unit 90
Sumter, SC 29150
Phone (912) 856-9698

NPI Registry JSON

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

{
    "created_epoch": "1589500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589500800000",
    "number": "1336761097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 CENTRE POINTE DR STE 201",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294186997",
            "telephone_number": "912-856-9698",
            "fax_number": "843-781-7403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 BROAD ST UNIT 90",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291501984",
            "telephone_number": "912-856-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OAK DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-15",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "GONG",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-371-2516"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Home EB5 VII",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sumter, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.