NPIMap

Organization Active NPI

Smile Center of Knightsville

  • General Practice Dentistry
  • Summerville, SC
National Provider Identifier
1558543249
Registry record updated Dec 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4061 Issued in SC
Legal business name
SMILE CENTER OF KNIGHTSVILLE
Doing business as
Smile Center of Knightsville
Practice address
100 Omalley Dr
Suite B
Summerville, SC 29483-5635
Phone
(843) 261-0123
Fax
(843) 261-0125
NPI assigned
Dec 4, 2007
Last updated
Dec 4, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2007

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

Authorized official

Name
Dr. Jeanine Alicia Gourdine, D.M.D.NPI 1427014786
Title
Owner/Dentist
Phone
(843) 261-0123

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 4061 SC Primary

Addresses

Primary practice location

100 Omalley Dr
Suite B
Summerville, SC 29483-5635

Mailing address

100 Omalley Dr
Suite B
Summerville, SC 29483-5635
Phone (843) 261-0123

Other identifiers 1

IdentifierTypeStateIssuer
ZX4061MedicaidSC

Other names 1

  • Smile Center of Knightsville Doing business as

National Provider Directory

National Provider Directory

Locations

100 Omalley Dr
Unit B
Summerville, SC 29483
Phone (843) 261-0123

Practitioners & affiliated clinicians

Practitioners 2

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": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1558543249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 OMALLEY DR",
            "address_2": "SUITE B",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294835635",
            "telephone_number": "843-261-0123",
            "fax_number": "843-261-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 OMALLEY DR",
            "address_2": "SUITE B",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294835635",
            "telephone_number": "843-261-0123",
            "fax_number": "843-261-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE CENTER OF KNIGHTSVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "GOURDINE",
        "authorized_official_first_name": "JEANINE",
        "authorized_official_middle_name": "ALICIA",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "843-261-0123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX4061",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Center of Knightsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summerville, SC

Sources for this page

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