NPIMap

Organization Active NPI

Timothy I. McConnell D.M.D. P.a.

  • General Practice Dentistry
  • Goose Creek, SC
National Provider Identifier
1528016573
Registry record updated Apr 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1759 Issued in SC
Legal business name
TIMOTHY I. MCCONNELL D.M.D. P.A.
Practice address
100 Berkeley Square LN
Goose Creek, SC 29445-2958
Phone
(843) 553-5235
Fax
(843) 797-8189
NPI assigned
May 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2011

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

Authorized official

Name
Timothy Ivan McConnell, D.M.DNPI 1235187501
Title
Owner
Phone
(843) 553-5235

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 1759 SC Primary

Addresses

Primary practice location

100 Berkeley Square LN
Goose Creek, SC 29445-2958

Mailing address

PO Box 1120
Goose Creek, SC 29445-1120
Phone (843) 553-5235

Other identifiers 2

IdentifierTypeStateIssuer
179343OtherSCUNITED CONCORDIA INS #
Z17599MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1528016573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1120",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294451120",
            "telephone_number": "843-553-5235",
            "fax_number": "843-797-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BERKELEY SQUARE LN",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294452958",
            "telephone_number": "843-553-5235",
            "fax_number": "843-797-8189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY I. MCCONNELL D.M.D. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "MCCONNELL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "IVAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-553-5235",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "1759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INS #",
            "identifier": "179343",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z17599",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goose Creek, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; 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.