Individual provider Active NPI

Robert Scott Anderson, DDS

  • General Practice Dentistry
  • Salem, SC
National Provider Identifier
1720191968
Registry record updated Oct 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4549 Issued in SC
Practice address
25 Eastern PT
Salem, SC 29676
Phone
(864) 719-0079
Fax
(864) 719-0079
NPI assigned
Aug 15, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4549SCMDPhysical Therapist

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4549 SC Primary

Addresses

NPPES NPI Registry

Primary practice location

25 Eastern PT
Salem, SC 29676

Mailing address

25 Eastern PT
Salem, SC 29676
Phone (864) 719-0079

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
0608524MedicaidOH

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 14, 2016.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476403200000",
    "number": "1720191968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 EASTERN PT",
            "city": "SALEM",
            "state": "SC",
            "postal_code": "29676",
            "telephone_number": "864-719-0079",
            "fax_number": "864-719-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 EASTERN PT",
            "city": "SALEM",
            "state": "SC",
            "postal_code": "29676",
            "telephone_number": "864-719-0079",
            "fax_number": "864-719-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "ROBERT",
        "middle_name": "SCOTT",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2016-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0608524",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2016; 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.