NPIMap

Organization Active NPI

Prime Dental of Woodruff

  • Dentist
  • Woodruff, SC
National Provider Identifier
1407918014
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
1863 Issued in SC
Legal business name
PRIME DENTAL OF WOODRUFF
Practice address
420 S Main St
Woodruff, SC 29388-2117
Phone
(864) 476-3212
Fax
(864) 476-3212
NPI assigned
Dec 14, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Asa Duncan Shirley III, DMDNPI 1891918512
Title
Owner
Phone
(864) 834-8001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 1863 SC Primary

Addresses

Primary practice location

420 S Main St
Woodruff, SC 29388-2117

Mailing address

420 S Main St
Woodruff, SC 29388-2117
Phone (864) 476-3212

Other identifiers 1

IdentifierTypeStateIssuer
ZA9487MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407918014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S MAIN ST",
            "city": "WOODRUFF",
            "state": "SC",
            "postal_code": "293882117",
            "telephone_number": "864-476-3212",
            "fax_number": "864-476-3212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S MAIN ST",
            "city": "WOODRUFF",
            "state": "SC",
            "postal_code": "293882117",
            "telephone_number": "864-476-3212",
            "fax_number": "864-476-3212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME DENTAL OF WOODRUFF",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHIRLEY",
        "authorized_official_first_name": "ASA",
        "authorized_official_middle_name": "DUNCAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-834-8001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "1863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9487",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodruff, SC

Sources for this page

  • 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.