NPIMap

Organization Active NPI

Cosmetic & Family Dentistry PC

  • General Practice Dentistry
  • Hanahan, SC
National Provider Identifier
1497807903
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
003636 Issued in SC
Legal business name
COSMETIC & FAMILY DENTISTRY PC
Practice address
1224 Yeamans Hall Rd
Hanahan, SC 29406
Phone
(843) 554-4545
Fax
(843) 554-4548
NPI assigned
Jan 17, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. John Bradley Palles, DMDNPI 1568718351
Title
Pres of Cosmetic & Family Dentistry
Phone
(843) 554-4545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 003636 SC Primary

Addresses

Primary practice location

1224 Yeamans Hall Rd
Hanahan, SC 29406

Mailing address

1224 Yeamans Hall Rd
Hanahan, SC 29406
Phone (843) 554-4545

Other identifiers 1

IdentifierTypeStateIssuer
ZX3636MedicaidSC

Other names 1

  • John Bradley Palles DMD Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497807903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 YEAMANS HALL RD",
            "city": "HANAHAN",
            "state": "SC",
            "postal_code": "29406",
            "telephone_number": "843-554-4545",
            "fax_number": "843-554-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 YEAMANS HALL RD",
            "city": "HANAHAN",
            "state": "SC",
            "postal_code": "29406",
            "telephone_number": "843-554-4545",
            "fax_number": "843-554-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMETIC & FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PALLES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "PRES OF COSMETIC & FAMILY DENTISTRY",
        "authorized_official_telephone_number": "843-554-4545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "003636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3636",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John Bradley Palles DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hanahan, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.