Individual provider Active NPI

Landi Jennifer Rosenau, DDS

  • General Practice Dentistry
  • Indian Land, SC
National Provider Identifier
1366965337
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9798 Issued in SC
Practice address
9456 Charlotte Hwy Ste 202
Indian Land, SC 29707-7953
Phone
(803) 766-7973
NPI assigned
Jul 21, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 9798 SC Primary
General Practice Dentistry 1223G0001X 10814 NC

Addresses

Primary practice location

9456 Charlotte Hwy Ste 202
Indian Land, SC 29707-7953

Mailing address

958 Meadow Vista Dr
Waxhaw, NC 28173-5011
Phone (704) 607-1678

Other identifiers 2

IdentifierTypeStateIssuer
10814OtherNCDENTAL LISENCE
9798OtherSCDENTAL LISENCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
10814NCMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1500595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1366965337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "958 MEADOW VISTA DR",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281735011",
            "telephone_number": "704-607-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9456 CHARLOTTE HWY STE 202",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297077953",
            "telephone_number": "803-766-7973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENAU",
        "first_name": "LANDI",
        "middle_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-21",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "9798",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "10814",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LISENCE",
            "identifier": "10814",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LISENCE",
            "identifier": "9798",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indian Land, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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.