South County Family Dental, Inc

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SOUTH COUNTY FAMILY DENTAL, INC

Practice address

12660 Lamplighter Square SHPG Ctr Ste G
Saint Louis, MO 63128-2761

Phone

(314) 843-4040

NPI assigned

May 18, 2021

Organization subpart

No

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

Authorized official

Name

Carl GravesNPI 1295188761

Title

DDS

Phone

(850) 712-2307

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carl Stephen Graves, D.D.S.

  • Dentist
  • Fort Walton Beach, FL
  • NPI 1295188761
  NPD Authorized official

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

{
    "created_epoch": "1621296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1568036192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12660 LAMPLIGHTER SQUARE SHPG CTR STE G",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282761",
            "telephone_number": "314-843-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12660 LAMPLIGHTER SQUARE SHPG CTR STE G",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282761",
            "telephone_number": "314-843-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY FAMILY DENTAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-18",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "850-712-2307"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South County Anesthesia Associates, LTD.
• South County Comprehensive Care LLC
• South County Dental Imaging Center
• South County Endocrinology and Obesity Medicine LLC
• South County Eye Care
• South County Imaging Center LLC
• South County Internal Medicine Inc.
• South County Orthopedics and Sports Medicine Inc
• South County Outpatient Surgery Center LP
• South County Pain Institute LLC

• Dentist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; 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.