Prime Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PRIME DENTAL LLC

Practice address

4130 Clemson Blvd
Anderson, SC 29621

Phone

(864) 332-1266

Fax

(864) 261-6988

NPI assigned

Jul 17, 2019

Last updated

Jul 17, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

PRIME DENTAL LLCAs reported in NPPES

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

Authorized official

Name

Asa Duncan Shirley, DMD

Title

Owner/Dentist

Phone

(864) 332-1266

Specialties & licenses 1

Addresses

Other identifiers 2

Part of

Prime Dental LLC

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

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563321600000",
    "number": "1629621933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4130 CLEMSON BLVD",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "29621",
            "telephone_number": "864-332-1266",
            "fax_number": "864-332-1266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 CLEMSON BLVD",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "29621",
            "telephone_number": "864-332-1266",
            "fax_number": "864-261-6988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME DENTAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIME DENTAL LLC",
        "enumeration_date": "2019-07-17",
        "last_updated": "2019-07-17",
        "status": "A",
        "authorized_official_last_name": "SHIRLEY",
        "authorized_official_first_name": "ASA",
        "authorized_official_middle_name": "DUNCAN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "864-332-1266",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "-",
            "identifier": "ZZ2657",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218632",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Austin James Priaulx, DO
• Jordan Bryant Price, DNP, APRN, AGNP-C
• Kayla H Price
• Melissa Price
• Primary Care Associates, PC (Primary Care Associates)
• Prisma Health Imaging Centers, LLC (PH Imaging Center Anderson)
• Prisma Health-Upstate (Prisma Health Primary Care Northlake)
• Prisma Health-Upstate (PH Primary Care Liberty Highway)
• Donna B Proctor, CRNA
• Progrin Dental of North Anderson, LLC

• General Practice Dentistry in Anderson, SC
• Providers in Anderson, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.