NPIMap

Organization Active NPI

Edisto Dental Associates of SC, LLC

  • Exclusive Provider Organization
  • Edisto Island, SC
National Provider Identifier
1386891463
Registry record updated Aug 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
License
2109 Issued in SC
Legal business name
EDISTO DENTAL ASSOCIATES OF SC, LLC
Practice address
51 Station CT Ste C
Edisto Island, SC 29438-3020
Phone
(843) 869-3368
NPI assigned
Aug 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2008

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

Authorized official

Name
Mrs. Julie Corley
Title
Office Manager
Phone
(803) 279-0015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X 2109 SC Primary

Addresses

Primary practice location

51 Station CT Ste C
Edisto Island, SC 29438-3020

Mailing address

PO Box 218
Edisto Island, SC 29438-0218
Phone (843) 869-3368

Other names 1

  • J. Michael Havird, DMD, PC Former legal business name

National Provider Directory

National Provider Directory

Locations

51 Station Ct
Ste C
Edisto Island, SC 29438
Phone (843) 869-3368

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219190400000",
    "number": "1386891463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "EDISTO ISLAND",
            "state": "SC",
            "postal_code": "294380218",
            "telephone_number": "843-869-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 STATION CT STE C",
            "city": "EDISTO ISLAND",
            "state": "SC",
            "postal_code": "294383020",
            "telephone_number": "843-869-3368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISTO DENTAL ASSOCIATES OF SC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-20",
        "last_updated": "2008-08-20",
        "status": "A",
        "authorized_official_last_name": "CORLEY",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-279-0015",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "SC",
            "license": "2109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "J. Michael Havird, DMD, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Edisto Island, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; 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.