Tidelands Dental on Glenns Bay LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TIDELANDS DENTAL ON GLENNS BAY LLC

Practice address

1625 Glenns Bay Rd
Surfside Beach, SC 29575-4836

Phone

(843) 650-4500

Fax

(843) 650-4510

NPI assigned

Jan 24, 2020

Last updated

Jan 24, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Peter Jones

Title

Business Manager

Phone

(603) 531-1001

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579824000000",
    "number": "1619507019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3577 MARION LN",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295766012",
            "telephone_number": "603-531-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 GLENNS BAY RD",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295754836",
            "telephone_number": "843-650-4500",
            "fax_number": "843-650-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDELANDS DENTAL ON GLENNS BAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-24",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "603-531-1001"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@tidelandsdental.com",
            "affiliation": "N",
            "endpointDescription": "encrypted email through aspida.us",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "encrypted email",
            "address_1": "1625 Glenns Bay Rd",
            "city": "Surfside Beach",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295754836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; 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.