NPIMap

Organization Active NPI

Southern Oak Dental, LLC

  • General Practice Dentistry
  • Conway, SC
National Provider Identifier
1497225916
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SOUTHERN OAK DENTAL, LLC
Practice address
2676 Church St Unit a
Conway, SC 29526-4471
Phone
(843) 331-3237
NPI assigned
Nov 27, 2018
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Frank Gong
Title
Owner
Phone
(206) 371-2516

National Provider Directory

National Provider Directory
Tax ID family
Southern Oak Dental LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

NPPES NPI Registry

Primary practice location

2676 Church St Unit a
Conway, SC 29526-4471

Mailing address

4921 Centre Pointe Dr Ste 201
N Charleston, SC 29418-6997
Phone (843) 909-1299

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 30, 2020.

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1497225916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 CENTRE POINTE DR STE 201",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294186997",
            "telephone_number": "843-909-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2676 CHURCH ST UNIT A",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295264471",
            "telephone_number": "843-331-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OAK DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-27",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "GONG",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-371-2516",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.