Childrens Dental Group of South Carolina

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2905 Issued in SC

Legal business name

CHILDRENS DENTAL GROUP OF SOUTH CAROLINA

Practice address

7210K Broad River Rd
Irmo, SC 29063-7973

Phone

(803) 781-1151

NPI assigned

Oct 23, 2008

Last updated

Oct 23, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gregory Wych

Title

Owner

Phone

(803) 781-1151

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1224720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224720000000",
    "number": "1417100371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7210K BROAD RIVER RD",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290637973",
            "telephone_number": "803-781-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7210K BROAD RIVER RD",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290637973",
            "telephone_number": "803-781-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS DENTAL GROUP OF SOUTH CAROLINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-23",
        "last_updated": "2008-10-23",
        "status": "A",
        "authorized_official_last_name": "WYCH",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-781-1151"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "2905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johanna Ellen Chapman, CCC-SLP
• Robert Wayne Chapman Jr., R.PH.
• Clint Cheeseboro
• Kristen Claire Cherry, PT, DPT
• Children and Adult Dental LLC (Broad River Dentistry)
• Useline Christolin
• Micaela Anne Cisson
• Civic Care Soluctions LLC
• Kelly Clark
• Marisol Paige Ann Clark, DPT

• General Practice Dentistry in Irmo, SC
• Providers in Irmo, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.