NPIMap

Organization Active NPI

Seaside Pediatric Dental Associates

  • Pediatric Dentistry
  • Murrells Inlet, SC
National Provider Identifier
1578084331
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SEASIDE PEDIATRIC DENTAL ASSOCIATES
Practice address
4410 Highway 17 Unit B6
Murrells Inlet, SC 29576
Phone
(423) 741-9078
NPI assigned
Jul 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Matthew Tillman, DDSNPI 1073809133
Title
Co-Owner
Phone
(843) 651-5437

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

4410 Highway 17 Unit B6
Murrells Inlet, SC 29576

Mailing address

4410 Highway 17 Unit B6
Murrells Inlet, SC 29576-6434
Phone (423) 741-9078

National Provider Directory

National Provider Directory

Locations

4410 Highway 17
Unit B6
Murrells Inlet, SC 29576
Phone (423) 741-9078

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": "1499040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1578084331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 HIGHWAY 17 UNIT B6",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295766434",
            "telephone_number": "423-741-9078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 HIGHWAY 17 UNIT B6",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "29576",
            "telephone_number": "423-741-9078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASIDE PEDIATRIC DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "843-651-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murrells Inlet, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.