Dentrust Dental South Carolina PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DENTRUST DENTAL SOUTH CAROLINA PC

Doing business as

DOCS Dental Ft.Jackson

Practice address

4712 Liberty Division Ave
Columbia, SC 29207-5405

Phone

(803) 334-0530

NPI assigned

Jun 18, 2024

Organization subpart

No

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

Authorized official

Name

Amanda Clark

Title

Director of Credentialing

Phone

(267) 927-5000

Specialties & licenses 1

Addresses

Other names 1

• DOCS Dental Ft.Jackson Doing business as

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

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1588407340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 VINEWOOD DR",
            "city": "SEFFNER",
            "state": "FL",
            "postal_code": "335844829",
            "telephone_number": "813-451-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4712 LIBERTY DIVISION AVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292075405",
            "telephone_number": "803-334-0530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTRUST DENTAL SOUTH CAROLINA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-18",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "267-927-5000"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DOCS Dental Ft.Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.