Organization Active NPI

Great Oaks LLC

  • General Practice Dentistry
  • Pickens, SC
National Provider Identifier
1659397149
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2359 Issued in SC
Legal business name
GREAT OAKS LLC
Practice address
108 Massingill Rd.
Pickens, SC 29671-2222
Phone
(864) 878-2428
Fax
(864) 878-3080
NPI assigned
Jul 15, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. William Pennington, DMDNPI 1578960357
Title
Owner
Phone
(864) 878-2428

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

Locations

108 Massingill Rd
Pickens, SC 29671
Phone (864) 878-2428

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2359 SC Primary

Addresses

NPPES NPI Registry

Primary practice location

108 Massingill Rd.
Pickens, SC 29671-2222

Mailing address

108 Massingill Rd
Pickens, SC 29671-2222
Phone (864) 878-2428

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
ZA9767MedicaidSC

Other names 1

NPPES NPI Registry
  • Great Oaks Dental Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 3, 2024.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1659397149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 MASSINGILL RD",
            "city": "PICKENS",
            "state": "SC",
            "postal_code": "296712222",
            "telephone_number": "864-878-2428",
            "fax_number": "864-878-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 MASSINGILL RD.",
            "city": "PICKENS",
            "state": "SC",
            "postal_code": "296712222",
            "telephone_number": "864-878-2428",
            "fax_number": "864-878-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT OAKS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2024-09-03",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-878-2428",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "2359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9767",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Oaks Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Pickens, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.