NPIMap

Organization Active NPI

Dental Professional of South Carolina, P.C.

Doing business as Dental Care on East Main

  • General Practice Dentistry
  • Easley, SC
National Provider Identifier
1649644873
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.
Doing business as
Dental Care on East Main
Practice address
1617 E Main St
Easley, SC 29640
Phone
(217) 540-8434
NPI assigned
Nov 27, 2015
Last updated
Jul 17, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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

Authorized official

Name
Kendra Walker
Title
Enrollment Team Lead
Phone
(217) 540-8513

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

1617 E Main St
Easley, SC 29640

Mailing address

1617 E Main St
Easley, SC 29640-3791

Other names 1

  • Dental Care on East Main Doing business as

National Provider Directory

National Provider Directory
Part of
Dental Professional of South Carolina PC

Locations

1617 E Main St
Easley, SC 29640
Phone (217) 540-8434

1004 Sea Mountain Hwy
North Myrtle Beach, SC 29582
Phone (843) 280-7776

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1448582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531785600000",
    "number": "1649644873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 E MAIN ST",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296403791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 E MAIN ST",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "29640",
            "telephone_number": "217-540-8434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONAL OF SOUTH CAROLINA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.",
        "enumeration_date": "2015-11-27",
        "last_updated": "2018-07-17",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "ENROLLMENT TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8513"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Care on East Main",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dental Care on East Main",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Easley, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; 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.