Alan Dzhabiev

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10249 Issued in SC

Practice address

140 Highway 274
Clover, SC 29710-6045

Phone

(803) 752-0565

NPI assigned

Jun 17, 2021

Last updated

Dec 3, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Wylie Modern Dentistry, PC

  dba Lake Wylie Modern Dentistry

  • Dentist
  • Lake Wylie, SC
  • NPI 1194376491
  NPD
• Ali Shahrestani, D.M.D., PLLC

  dba Piper Glen Dental Group

  • General Practice Dentistry
  • Charlotte, NC
  • NPI 1194591289
  NPD (past)
• Tangerine Dental Group, LLP

  dba Tangerine Dental Group

  • General Practice Dentistry
  • Oro Valley, AZ
  • NPI 1043459738
  NPD (past)

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1770151474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11177 N ORACLE RD APT 12104",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857375655",
            "telephone_number": "925-658-2252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 HIGHWAY 274",
            "city": "CLOVER",
            "state": "SC",
            "postal_code": "297106045",
            "telephone_number": "803-752-0565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6414 Rea Rd Ste C5",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282774165",
            "country_code": "US",
            "telephone_number": "704-704-2499",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1880 E Tangerine Rd Ste 190",
            "address_purpose": "LOCATION",
            "city": "Oro Valley",
            "state": "AZ",
            "postal_code": "857556239",
            "country_code": "US",
            "telephone_number": "520-544-5590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DZHABIEV",
        "first_name": "ALAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-17",
        "last_updated": "2024-12-03",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D011064",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "13000",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "epic",
            "affiliation": "N",
            "address_1": "1880 E Tangerine Rd Ste 190",
            "city": "Oro Valley",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "857556239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "epic",
            "affiliation": "N",
            "address_1": "1880 E Tangerine Rd Ste 190",
            "city": "Oro Valley",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "857556239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "epic",
            "affiliation": "N",
            "address_1": "1880 E Tangerine Rd Ste 190",
            "city": "Oro Valley",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "857556239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "epic",
            "affiliation": "N",
            "address_1": "1880 E Tangerine Rd Ste 190",
            "city": "Oro Valley",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "857556239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "epic",
            "affiliation": "N",
            "address_1": "1880 E Tangerine Rd Ste 190",
            "city": "Oro Valley",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "857556239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Dodds
• Shannon Lee Donohoe, PT, DPT
• Dragonfly Wellness Center, LLC (Dragonfly Wellness Center)
• Kimberly Hallman Drechsler, R. PH.
• Anna Dresdow, LPC
• East (East Medical Transport)
• John Wesley Edmunds III, DDS
• Nazila Eshraghi, DPM
• Brandon Fierro
• Beverly Frommel, CD

• General Practice Dentistry in Clover, SC
• Providers in Clover, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; 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.