Providence Dental Group LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

SC 3724 Issued in SC

Legal business name

PROVIDENCE DENTAL GROUP LLC

Practice address

220 Bridges Rd
Simpsonville, SC 29681-5700

Phone

(864) 675-6445

Fax

(864) 675-6447

NPI assigned

Mar 30, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jason Phillip MakowskiNPI 1396865705

Title

Member

Phone

(864) 675-6445

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jason Phillip Makowski

  • General Practice Dentistry
  • Simpsonville, SC
  • NPI 1396865705
  NPD (past) Authorized official

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760502181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 BRIDGES RD",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296815700",
            "telephone_number": "864-675-6445",
            "fax_number": "864-675-6447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 BRIDGES RD",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296815700",
            "telephone_number": "864-675-6445",
            "fax_number": "864-675-6447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAKOWSKI",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "PHILLIP",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "864-675-6445",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "SC 3724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Simpsonville, SC by specialty
• Dental Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.