NPIMap

Organization Active NPI

Martin Pediatric Dentistry, LLC

  • Pediatric Dentistry
  • Mauldin, SC
National Provider Identifier
1629230644
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
687 Issued in SC
Legal business name
MARTIN PEDIATRIC DENTISTRY, LLC
Practice address
218 New Neely Ferry Rd
Mauldin, SC 29662-2615
Phone
(864) 627-0029
NPI assigned
Jun 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

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

Authorized official

Name
Dr. Tu-Wanda Marable Martin
Title
Owner/Dentist
Phone
(864) 627-0029

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 687 SC Primary

Addresses

Primary practice location

218 New Neely Ferry Rd
Mauldin, SC 29662-2615

Mailing address

PO Box 962
Mauldin, SC 29662-0962
Phone (864) 627-0029

Other names 1

  • Mighty Mouths Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1629230644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 962",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296620962",
            "telephone_number": "864-627-0029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 NEW NEELY FERRY RD",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622615",
            "telephone_number": "864-627-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "TU-WANDA",
        "authorized_official_middle_name": "MARABLE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "864-627-0029",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mighty Mouths",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mauldin, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.