NPIMap

Organization Active NPI

Children's Dental Clinic of Charleston, LLC

Doing business as Children's Wellness Clinic

  • Nurse Practitioner
  • North Charleston, SC
National Provider Identifier
1730467978
Registry record updated Jul 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
N/A
Legal business name
CHILDREN'S DENTAL CLINIC OF CHARLESTON, LLC
Doing business as
Children's Wellness Clinic
Practice address
6035 Rivers Ave Ste a
North Charleston, SC 29406-5018
Phone
(843) 572-9909
Fax
(843) 572-9901
NPI assigned
Jul 21, 2011
Organization subpart
Yes
Parent organization
CHILDREN'S DENTAL CLINIC OF CHARLESTON, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2011

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

Authorized official

Name
Mrs. Jeanean S. Foster
Title
Director, Licensing & Credentialing
Phone
(615) 750-0342

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X N/A Primary

Addresses

Primary practice location

6035 Rivers Ave Ste a
North Charleston, SC 29406-5018

Mailing address

618 Church St
Suite 520
Nashville, TN 37219-2428
Phone (615) 750-0342

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidSC

Other names 1

  • Children's Wellness Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Charleston Youth Dentistry LLC2 organizations share this tax ID, including this one
Part of
Charleston Youth Dentistry LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

618 Church St
Ste 520
Nashville, TN 37219
Phone (615) 750-0342

Practitioners & affiliated clinicians

Practitioners 4

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": "1311206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311206400000",
    "number": "1730467978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 CHURCH ST",
            "address_2": "SUITE 520",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192428",
            "telephone_number": "615-750-0342",
            "fax_number": "615-986-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6035 RIVERS AVE STE A",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294065018",
            "telephone_number": "843-572-9909",
            "fax_number": "843-572-9901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTAL CLINIC OF CHARLESTON, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S DENTAL CLINIC OF CHARLESTON, LLC",
        "enumeration_date": "2011-07-21",
        "last_updated": "2011-07-21",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "JEANEAN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "DIRECTOR, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "615-750-0342",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; 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.