NPIMap

Organization Active NPI

Dental Professional of SC

Doing business as South Aiken Dental Care

  • General Practice Dentistry
  • Aiken, SC
National Provider Identifier
1548685191
Registry record updated Feb 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONAL OF SC
Doing business as
South Aiken Dental Care
Practice address
1055 Pine Log Rd
Aiken, SC 29803-7396
Phone
(803) 761-7924
NPI assigned
Feb 19, 2014
Last updated
Feb 19, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONAL OF SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2014

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

Authorized official

Name
Jean Cornell
Title
Insurance/Credentialing
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

1055 Pine Log Rd
Aiken, SC 29803-7396

Mailing address

1055 Pine Log Rd
Aiken, SC 29803-7396

Other names 1

  • South Aiken Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of SC PC74 organizations share this tax ID, including this one
Part of
Dental Professionals of SC PC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1055 Pine Log Rd
Aiken, SC 29803
Phone (803) 226-9244

NPI Registry JSON

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

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392768000000",
    "number": "1548685191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 PINE LOG RD",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298037396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 PINE LOG RD",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298037396",
            "telephone_number": "803-761-7924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONAL OF SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONAL OF SC",
        "enumeration_date": "2014-02-19",
        "last_updated": "2014-02-19",
        "status": "A",
        "authorized_official_last_name": "CORNELL",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "INSURANCE/CREDENTIALING",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Aiken Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aiken, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; 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.