Active NPI
Lake City Family Dentistry
- Dentist
- Lake City, SC
National Provider Identifier
1689710139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- SC3558
- Legal business name
- LAKE CITY FAMILY DENTISTRY
- Practice address
- 804 W Main St
Lake City, SC 29560-4400 - Phone
- (843) 374-2021
- Fax
- (843) 374-2030
- NPI assigned
- Jan 30, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Windy Hobbs
- Title
- Insurance Clerk
- Phone
- (843) 374-2021
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | SC3558 | SC | Primary |
Addresses
Primary practice location
804 W Main St
Lake City, SC 29560-4400
Mailing address
804 W Main St
Lake City, SC 29560-4400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZA9757 | Medicaid | SC |
National Provider Directory
National Provider Directory- Tax ID family
- Lake City Family Dentistry
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dentist
- Lake City, SC
- NPI 1770671968
Locations
804 W Main St
Lake City, SC 29560
Phone (843) 374-2021
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dentist
- Lake City, SC
- NPI 1518055870
-
- Dentist
- Lake City, SC
- NPI 1629166889
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1200441600000",
"number": "1689710139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 W MAIN ST",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "295604400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "804 W MAIN ST",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "295604400",
"telephone_number": "843-374-2021",
"fax_number": "843-374-2030"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKE CITY FAMILY DENTISTRY",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-30",
"last_updated": "2008-01-16",
"status": "A",
"authorized_official_last_name": "HOBBS",
"authorized_official_first_name": "WINDY",
"authorized_official_title_or_position": "INSURANCE CLERK",
"authorized_official_telephone_number": "843-374-2021"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "SC",
"license": "SC3558",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZA9757",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake City, SC
- Lake City - Kingstree Radiology, PC
- Lake City Adult Day Care, Inc.
- Lake City Community Day Services, Inc.
- Lake City Community Day Services, Inc.
- Lake City Diagnostic Imaging, Inc.
- Lake City Family Dentistry
- Lake City Family Medicine LLC
- Lake City Family Medicine LLC
- Lake City Medical Associates 2017, LLC
- Lake City Orthopaedic Clinic
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.