NPIMap

Organization Active NPI

Dental Professional of South Carolina, P.C.

  • General Practice Dentistry
  • Fort Mill, SC
National Provider Identifier
1578034369
Registry record updated Mar 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.
Practice address
2373 Len Patterson Rd Ste 103
Fort Mill, SC 29708-8266
Phone
(803) 310-6109
NPI assigned
Dec 6, 2018
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2019

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

Authorized official

Name
Jessica Britt
Title
Credentialing Coordinator
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2373 Len Patterson Rd Ste 103
Fort Mill, SC 29708-8266

Mailing address

2373 Len Patterson Rd Ste 103
Fort Mill, SC 29708-8266
Phone (803) 752-0655

Other names 1

  • Dental Care at Mills Crossing Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professional of South Carolina PC74 organizations share this tax ID, including this one
Part of
Dental Professional of South Carolina 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

2373 Len Patterson Rd
Ste 103
Fort Mill, SC 29708
Phone (803) 310-6109

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1544054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553817600000",
    "number": "1578034369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2373 LEN PATTERSON RD STE 103",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088266",
            "telephone_number": "803-752-0655",
            "fax_number": "803-396-0029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 LEN PATTERSON RD STE 103",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088266",
            "telephone_number": "803-310-6109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.",
        "enumeration_date": "2018-12-06",
        "last_updated": "2019-03-29",
        "status": "A",
        "authorized_official_last_name": "BRITT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Care at Mills Crossing",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dental Care at Mills Crossing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Mill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2019; 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.