Active NPI
Joseph John Krupa III, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Columbia, SC
National Provider Identifier
1427121078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 9256
- Practice address
- 3304 Forest Dr
Columbia, SC 29204-4024 - Phone
- (803) 551-2572
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 6496 | NC | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 9256 | SC | Primary |
Addresses
Primary practice location
3304 Forest Dr
Columbia, SC 29204-4024
Mailing address
PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320
Other practice location 1
2250 Shipyard Blvd
Suite 15
Wilmington, NC 28403-8024
Phone (910) 399-3216
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZX9256 | Medicaid | SC | |
| 8995063 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6496 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588636800000",
"number": "1427121078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 743904",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303743904",
"telephone_number": "803-296-7320",
"fax_number": "803-296-7330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3304 FOREST DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292044024",
"telephone_number": "803-551-2572"
}
],
"practiceLocations": [
{
"address_1": "2250 Shipyard Blvd",
"address_2": "Suite 15",
"address_purpose": "LOCATION",
"city": "Wilmington",
"state": "NC",
"postal_code": "284038024",
"country_code": "US",
"telephone_number": "910-399-3216",
"fax_number": "910-399-3693",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KRUPA",
"first_name": "JOSEPH",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2020-05-05",
"certification_date": "2020-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "NC",
"license": "6496",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "SC",
"license": "9256",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZX9256",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8995063",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.