Immediate Dental Group Columbia

Primary specialty

DentistTaxonomy code 122300000X

License

SC2662 Issued in SC

Legal business name

IMMEDIATE DENTAL GROUP COLUMBIA

Practice address

1118 Greenlawn Drive
Columbia, SC 29209

Phone

(803) 807-2140

Fax

(803) 807-2141

NPI assigned

Nov 6, 2012

Organization subpart

No

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

Authorized official

Name

Zachary Todd Daugherty

Title

Business Manager

Phone

(910) 526-3487

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352160000000",
    "number": "1790039212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 GREENLAWN DRIVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29209",
            "telephone_number": "803-807-2140",
            "fax_number": "803-807-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 GREENLAWN DRIVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29209",
            "telephone_number": "803-807-2140",
            "fax_number": "803-807-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMEDIATE DENTAL GROUP COLUMBIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2012-11-06",
        "status": "A",
        "authorized_official_last_name": "DAUGHERTY",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "910-526-3487"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "SC2662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Columbia, SC
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• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; 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.