NPIMap

Organization Active NPI

Southern Roots Periodontics: Implant & Laser Dentistry, LLC

  • Dental Clinic/Center
  • Columbia, SC
National Provider Identifier
1578009056
Registry record updated Jan 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
8489 Issued in SC
Legal business name
SOUTHERN ROOTS PERIODONTICS: IMPLANT & LASER DENTISTRY, LLC
Practice address
2120 N Beltline Blvd
Columbia, SC 29204-4518
Phone
(803) 782-0528
Fax
(803) 782-1036
NPI assigned
Jan 9, 2017
Last updated
Jan 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2017

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

Authorized official

Name
Dr. Matthew Joseph Rowe, D.D.S., M.S.D.NPI 1922356997
Title
Owner/Manager
Phone
(803) 782-0528

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
Dental Clinic/Center 261QD0000X 8489 SC Primary

Addresses

Primary practice location

2120 N Beltline Blvd
Columbia, SC 29204-4518

Mailing address

2120 N Beltline Blvd
Columbia, SC 29204-4518
Phone (803) 782-0528

Other names 1

  • South Carolina Periodontology Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483920000000",
    "number": "1578009056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 N BELTLINE BLVD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292044518",
            "telephone_number": "803-782-0528",
            "fax_number": "803-782-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 N BELTLINE BLVD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292044518",
            "telephone_number": "803-782-0528",
            "fax_number": "803-782-1036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ROOTS PERIODONTICS: IMPLANT & LASER DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-09",
        "last_updated": "2017-01-09",
        "status": "A",
        "authorized_official_last_name": "ROWE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "803-782-0528",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S.D."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "8489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Carolina Periodontology",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; 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.