Ladys Island Denal Clinic

Primary specialty

DentistTaxonomy code 122300000X

License

3760 Issued in SC

Legal business name

LADYS ISLAND DENAL CLINIC

Practice address

5 Professional Village Cir
Beaufort, SC 29907-1571

Phone

(843) 521-0808

Fax

(843) 521-0945

NPI assigned

Mar 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tristan H Greenwalt, DMDNPI 1518940980

Title

Dentist

Phone

(843) 521-0808

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tristan Greenwalt, DMD

  • General Practice Dentistry
  • Beaufort, SC
  • NPI 1518940980
  NPD (past) Authorized official
• Angela L Litchfield, DMD

  • General Practice Dentistry
  • Beaufort, SC
  • NPI 1386762342
  NPD (past)

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386761955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 PROFESSIONAL VILLAGE CIR",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299071571",
            "telephone_number": "843-521-0808",
            "fax_number": "843-521-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PROFESSIONAL VILLAGE CIR",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299071571",
            "telephone_number": "843-521-0808",
            "fax_number": "843-521-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LADYS ISLAND DENAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREENWALT",
        "authorized_official_first_name": "TRISTAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "843-521-0808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "3760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "923437",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3760",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3797",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9682",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "970484",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kerianne Krause
• Charles H Kresch, DDS
• Gordon E Krueger, MD
• Cristina Marie Laabs
• Patricia R. Labby, RN
• Henry Lucius Laffitte Jr., MD
• Denis Alan Laird, D.D.S.
• Mark Paul Lambrecht, OD
• Sean Patrick Lammy, DDS
• Jordan Landry

• Dentist in Beaufort, SC
• Providers in Beaufort, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.