NPIMap

Organization Active NPI

Dental Professionals of South Carolina, P.C.

  • General Practice Dentistry
  • Blythewood, SC
National Provider Identifier
1730455965
Registry record updated Apr 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Practice address
213 Main Street
Blythewood, SC 29016-0589
Phone
(803) 754-9545
Fax
(803) 754-2158
NPI assigned
Apr 2, 2012
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2012

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

Authorized official

Name
Kim Wilson
Title
Credentialing Coordinator
Phone
(217) 540-5170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

213 Main Street
Blythewood, SC 29016-0589

Mailing address

PO Box 589
Blythewood, SC 29016-0589
Phone (803) 754-9545

Other names 1

  • Premier Dentistry of Blythewood Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professional of South Carolina PC74 organizations share this tax ID, including this one
Part of
Dental Professional of South Carolina PC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

213 Main St
Blythewood, SC 29016
Phone (803) 753-9545

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333324800000",
    "number": "1730455965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 589",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290160589",
            "telephone_number": "803-754-9545",
            "fax_number": "803-754-2158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 MAIN STREET",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290160589",
            "telephone_number": "803-754-9545",
            "fax_number": "803-754-2158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.",
        "enumeration_date": "2012-04-02",
        "last_updated": "2012-04-02",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-5170"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Dentistry of Blythewood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blythewood, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; 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.