NPIMap

Organization Active NPI

Palms Dentistry 225, LLC

  • General Practice Dentistry
  • Fountain Inn, SC
National Provider Identifier
1669838991
Registry record updated Dec 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3949 Issued in SC
Legal business name
PALMS DENTISTRY 225, LLC
Practice address
208 Harrison Bridge Road
Fountain Inn, SC 29644
Phone
(864) 243-8371
Fax
(864) 243-8374
NPI assigned
Dec 31, 2015
Last updated
Dec 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2015

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

Authorized official

Name
Brian DerrickNPI 1063566396
Title
Owner/Dentist
Phone
(864) 243-8371

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3949 SC Primary

Addresses

Primary practice location

208 Harrison Bridge Road
Fountain Inn, SC 29644

Mailing address

208 Harrison Bridge Road
Fountain Inn, SC 29644
Phone (864) 243-8371

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1451520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451520000000",
    "number": "1669838991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 HARRISON BRIDGE ROAD",
            "city": "FOUNTAIN INN",
            "state": "SC",
            "postal_code": "29644",
            "telephone_number": "864-243-8371",
            "fax_number": "864-243-8374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 HARRISON BRIDGE ROAD",
            "city": "FOUNTAIN INN",
            "state": "SC",
            "postal_code": "29644",
            "telephone_number": "864-243-8371",
            "fax_number": "864-243-8374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMS DENTISTRY 225, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-31",
        "last_updated": "2015-12-31",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "864-243-8371"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Inn, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2015; 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.