Active NPI
Jennie O Reardon, DMD
- General Practice Dentistry
- Ladson, SC
National Provider Identifier
1568895357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8265
- Practice address
- 9565 Highway 78
Unit 600B
Ladson, SC 29456-4118 - Phone
- (843) 412-4036
- NPI assigned
- Aug 15, 2013
- Last updated
- Sep 20, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8265 | SC | Primary |
Addresses
Primary practice location
9565 Highway 78
Unit 600B
Ladson, SC 29456-4118
Mailing address
9565 Highway 78
Unit 600B
Ladson, SC 29456-4118
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8265 | SC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crane Family Dentistry LLC | Past | Accepting new patients | |
| Dr. Patricia Nicklas | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379635200000",
"number": "1568895357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9565 HIGHWAY 78",
"address_2": "UNIT 600B",
"city": "LADSON",
"state": "SC",
"postal_code": "294564118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9565 HIGHWAY 78",
"address_2": "UNIT 600B",
"city": "LADSON",
"state": "SC",
"postal_code": "294564118",
"telephone_number": "843-412-4036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REARDON",
"first_name": "JENNIE",
"middle_name": "O",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-15",
"last_updated": "2013-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "8265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ladson, SC
- Pro-Med 1 Inc (Pro Med 1)
- Pruitthealth Home Health, Inc. (PruittHealth Home Health - Charleston)
- Pruitthealth Hospice, Inc. (PruittHealth Hospice - Charleston)
- Antoinette Dominique Pryor, SLP
- Ja-Nae Quinones
- Kara Reed, OTD, OTR/L
- Gladys Sujey Reyes, OTR/L
- Brooke Lane Richardson, DPT
- Tanner Richberg, MS, CSCS, CEP
- Jordan Luisa Ricketts, MS CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.