NPIMap

Organization Active NPI

South Carolina Dental Sleep Center, LLC

Doing business as South Carolina Dental Sleep, Five Forks

  • Dentist
  • Simpsonville, SC
National Provider Identifier
1669039483
Registry record updated May 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SOUTH CAROLINA DENTAL SLEEP CENTER, LLC
Doing business as
South Carolina Dental Sleep, Five Forks
Practice address
216 Scuffletown Rd Ste a
Simpsonville, SC 29681-7296
Phone
(864) 207-7141
Fax
(864) 751-7329
NPI assigned
May 28, 2019
Last updated
May 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2019

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

Authorized official

Name
Mrs. Beth Louise Illsley
Title
Director of Insurance
Phone
(864) 282-1935

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

216 Scuffletown Rd Ste a
Simpsonville, SC 29681-7296

Mailing address

110 Villa Rd
Greenville, SC 29615-3010
Phone (864) 282-1935

Other names 1

  • South Carolina Dental Sleep, Five Forks Doing business as

National Provider Directory

National Provider Directory
Tax ID family
South Carolina Dental Sleep Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

216 Scuffletown Rd
Ste A
Simpsonville, SC 29681
Phone (864) 207-7141

NPI Registry JSON

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

{
    "created_epoch": "1559001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559001600000",
    "number": "1669039483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 VILLA RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153010",
            "telephone_number": "864-282-1935",
            "fax_number": "864-751-6387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 SCUFFLETOWN RD STE A",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296817296",
            "telephone_number": "864-207-7141",
            "fax_number": "864-751-7329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CAROLINA DENTAL SLEEP CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-28",
        "last_updated": "2019-05-28",
        "status": "A",
        "authorized_official_last_name": "ILLSLEY",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "DIRECTOR OF INSURANCE",
        "authorized_official_telephone_number": "864-282-1935",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Carolina Dental Sleep, Five Forks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Simpsonville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.