Russell S. Eddy, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

3662 Issued in SC

Practice address

277 B Willbrook Blvd
Pawleys Island, SC 29585

Phone

(843) 235-9780

Fax

(843) 235-8444

NPI assigned

May 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coastal Endontics, LLC

  • Dental Clinic/Center
  • Pawleys Island, SC
  • NPI 1093996282
  NPD (past) Authorized official

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193788800000",
    "number": "1477501575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 B WILLBROOK BLVD",
            "address_2": "P. O. BOX 4776",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "29585",
            "telephone_number": "843-235-9780",
            "fax_number": "843-235-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 B WILLBROOK BLVD",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "29585",
            "telephone_number": "843-235-9780",
            "fax_number": "843-235-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDDY",
        "first_name": "RUSSELL",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2007-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "SC",
            "license": "3662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Disability and Autism Services of South Carolina
• Diane A Dolan, RN
• Carlie Gordon Dorsey, OTRL
• Kimberley Anastasia Drayton, M.D.
• Joyce Ann Eckard, MSPT
• Kathryn Anna Epperson, MD
• Carolyn Eskridge, MD
• Nichole Marie Evans, FNP
• Robert H. Fabrey II, MD
• Family Dental Health Group LLC

• Endodontics in Pawleys Island, SC
• Providers in Pawleys Island, SC by specialty
• Endodontics in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.