Pedo Carolina, Inc.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

4509-798 Issued in SC

Legal business name

PEDO CAROLINA, INC.

Doing business as

Rock Hill Pediatric Dentistry

Practice address

2460 India Hook Rd Ste 106
Rock Hill, SC 29732-3530

Phone

(704) 763-4931

NPI assigned

Sep 13, 2013

Organization subpart

No

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

Authorized official

Name

Jonathan Mark Mitchell, DMD, PHD, MSD

Title

President/Owner

Phone

(704) 763-4931

Specialties & licenses 1

Addresses

Other names 1

• Rock Hill Pediatric Dentistry Doing business as

Locations

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

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379030400000",
    "number": "1770918351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 INDIA HOOK RD STE 106",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323530",
            "telephone_number": "704-763-4931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 INDIA HOOK RD STE 106",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323530",
            "telephone_number": "704-763-4931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDO CAROLINA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-13",
        "last_updated": "2013-09-13",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "704-763-4931",
        "authorized_official_credential": "DMD, PHD, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "4509-798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rock Hill Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carlos G Paxtor, M.D.
• Danielle Gloria Payne, PHARMD
• Jane Pearson, RN
• Celeste M Peddy
• Pediatric Eye Care & Strabismus, P.C.
• Jennifer E Peelman, PA-C
• Alphonso Peeples, DDS
• Joy Pendarvis, CF-SLP
• Amanda Marie Pennington, M.D.
• Larry H Pennington, MD

• Pediatric Dentistry in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2013; 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.