NPIMap

Organization Active NPI

Marshlands II Family Dentistry, PA

  • Dental Clinic/Center
  • Beaufort, SC
National Provider Identifier
1780184036
Registry record updated Feb 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
4601 Issued in SC
Legal business name
MARSHLANDS II FAMILY DENTISTRY, PA
Practice address
1090 Ribaut Rd
Beaufort, SC 29902-5437
Phone
(843) 521-4344
Fax
(843) 521-1804
NPI assigned
Feb 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2018

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

Authorized official

Name
Dr. John David Southerland Wise, DMD
Title
General Dentist
Phone
(843) 521-4344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 4601 SC Primary

Addresses

Primary practice location

1090 Ribaut Rd
Beaufort, SC 29902-5437

Mailing address

1090 Ribaut Rd
Beaufort, SC 29902-5437
Phone (843) 521-4344

Other identifiers 4

IdentifierTypeStateIssuer
ZX4601MedicaidSC
1134233935OtherSCNPI
1548499635OtherSCNPI
Z17777MedicaidSC

Other names 1

  • Marshlands Family Dentistry Doing business as

National Provider Directory

National Provider Directory

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": "1518480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518480000000",
    "number": "1780184036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 RIBAUT RD",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025437",
            "telephone_number": "843-521-4344",
            "fax_number": "843-521-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 RIBAUT RD",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025437",
            "telephone_number": "843-521-4344",
            "fax_number": "843-521-1804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHLANDS II FAMILY DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-13",
        "last_updated": "2018-02-13",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "JOHN DAVID",
        "authorized_official_middle_name": "SOUTHERLAND",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "843-521-4344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "4601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX4601",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1134233935",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1548499635",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z17777",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marshlands Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaufort, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2018; 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.