NPIMap

Organization Active NPI

Southlake Family Dentistry LLC

  • General Practice Dentistry
  • Fort Mill, SC
National Provider Identifier
1487670667
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2588 Issued in SC
Legal business name
SOUTHLAKE FAMILY DENTISTRY LLC
Practice address
1741 Gold Hill Rd
Suite 2010
Fort Mill, SC 29708-8202
Phone
(803) 548-3342
Fax
(803) 548-3817
NPI assigned
Jul 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

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

Authorized official

Name
Dr. Gary C Kimsey, D.M.D.,F.A.G.D.
Title
President
Phone
(803) 548-3342

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 2588 SC Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 3549 SC

Addresses

Primary practice location

1741 Gold Hill Rd
Suite 2010
Fort Mill, SC 29708-8202

Mailing address

1741 Gold Hill Rd
Suite 2010
Fort Mill, SC 29708-8202
Phone (803) 548-3342

National Provider Directory

National Provider Directory

Locations

1741 Gold Hill Rd
Ste 2010
Fort Mill, SC 29708
Phone (803) 548-3342

Practitioners & affiliated clinicians

Practitioners 5

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": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1487670667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1741 GOLD HILL RD",
            "address_2": "SUITE 2010",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088202",
            "telephone_number": "803-548-3342",
            "fax_number": "803-548-3817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1741 GOLD HILL RD",
            "address_2": "SUITE 2010",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088202",
            "telephone_number": "803-548-3342",
            "fax_number": "803-548-3817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "KIMSEY",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-548-3342",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D.,F.A.G.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "2588",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3549",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Mill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.