James Keith Bagwell, D.M.D.
Individual provider Active NPI General Practice Dentistry · Greer, SC
NPI 1356542583 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1356542583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3413 (SC)
- Practice address
- 1275 S Suber Rd
Greer, SC 29650-0940 - Phone
- (864) 877-2541
- NPI assigned
- May 28, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150731017274 | SC | Order and Referring Only - Dentist |
0042524274 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3413 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J Keith Bagwell DMD PA | General Practice | Past | Accepting new patients |
| Progrin Dental of Greer, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3413 | SC | Yes |
Addresses
Primary practice location
1275 S Suber Rd
Greer, SC 29650-0940
Mailing address
1275 S Suber Rd
Greer, SC 29650-0940
Phone (864) 877-2541
Other providers in Greer, SC
- B & B Angelic Home Health Care Services
- Oluwole Babatunde
- Jaclyn Weber Babcock
- Joe Babcock
- Andreea Iulia Babici
- Lauren Bailey
- Sara Myers Baird
- Jaqwiana Samia Baker
- Balanced Solution LLC
- Michael E. Baldwin
All providers in Greer, SC · General Practice Dentistry in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.