Spartanburg Smiles Youth Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SPARTANBURG SMILES YOUTH DENTISTRY, LLC

Practice address

371 Whitney Rd
Spartanburg, SC 29303-3143

Phone

(864) 515-0485

Fax

(864) 515-0985

NPI assigned

Jan 25, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Jenell Stump

Title

Manager, Licensing & Credentialing

Phone

(615) 750-0343

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1679543227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ARCADE UNIT 198747",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372191994",
            "telephone_number": "615-750-0343",
            "fax_number": "615-986-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 WHITNEY RD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033143",
            "telephone_number": "864-515-0485",
            "fax_number": "864-515-0985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG SMILES YOUTH DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "MANAGER, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "615-750-0343",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9484",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Spartanburg Rehabilitation Institute Inc
• Spartanburg Rehabilitation Institute Inc
• Spartanburg Rehabilitation Institute Inc.
• Spartanburg School District 7
• Spartanburg Senior Care
• Spartanburg Surgery Center, LLC
• Spartanburg Surgical Services, PA
• Spartanburg Vision LLC
• Anne Christine Spearman
• James Spearman, MD

• General Practice Dentistry in Spartanburg, SC
• Providers in Spartanburg, 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 9, 2014; 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.