NPIMap

Organization Active NPI

Welvista

Doing business as Summerton Smiles for a Lifetime

  • General Practice Dentistry
  • Summerton, SC
National Provider Identifier
1386727188
Registry record updated Sep 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WELVISTA
Doing business as
Summerton Smiles for a Lifetime
Practice address
9077 Alex Harvin Hwy
Summerton, SC 29148-9803
Phone
(803) 478-6277
Fax
(803) 478-6284
NPI assigned
Oct 23, 2006
Last updated
Sep 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2017

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

Authorized official

Name
Mrs. Georgia Bennett Famuliner
Title
Operations Director
Phone
(803) 584-4803

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

9077 Alex Harvin Hwy
Summerton, SC 29148-9803

Mailing address

PO Box 767
Summerton, SC 29148-0767
Phone (803) 478-6277

Other identifiers 1

IdentifierTypeStateIssuer
ZA9502MedicaidSC

Other names 1

  • Summerton Smiles for a Lifetime Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Welvista7 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.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505865600000",
    "number": "1386727188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 767",
            "city": "SUMMERTON",
            "state": "SC",
            "postal_code": "291480767",
            "telephone_number": "803-478-6277",
            "fax_number": "803-478-6284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9077 ALEX HARVIN HWY",
            "city": "SUMMERTON",
            "state": "SC",
            "postal_code": "291489803",
            "telephone_number": "803-478-6277",
            "fax_number": "803-478-6284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELVISTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2017-09-20",
        "status": "A",
        "authorized_official_last_name": "FAMULINER",
        "authorized_official_first_name": "GEORGIA",
        "authorized_official_middle_name": "BENNETT",
        "authorized_official_title_or_position": "OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "803-584-4803",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9502",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summerton Smiles for a Lifetime",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summerton, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2017; 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.