NPIMap

Organization Active NPI

Grand Strand Family and Esthetic Dentistry

  • Dentist
  • Myrtle Beach, SC
National Provider Identifier
1790971927
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2503 Issued in SC
Legal business name
GRAND STRAND FAMILY AND ESTHETIC DENTISTRY
Practice address
4884 Socastee Blvd
Myrtle Beach, SC 29588-7245
Phone
(843) 293-6606
NPI assigned
Sep 20, 2007
Organization subpart
Yes
Parent organization
GRAND STRAND FAMILY AND ESTHETIC DENTISTRYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

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

Authorized official

Name
Dr. Walter J Machowski, DMD
Title
Pres
Phone
(843) 293-6606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 2503 SC Primary

Addresses

Primary practice location

4884 Socastee Blvd
Myrtle Beach, SC 29588-7245

Mailing address

4884 Socastee Blvd
Myrtle Beach, SC 29588-7245
Phone (843) 293-6606

Other identifiers 1

IdentifierTypeStateIssuer
ZA9570MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Grand Strand Family and Esthetic Dentistry3 organizations share this tax ID, including this one
Part of
Grand Strand Family and Esthetic Dentistry

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4884 Socastee Blvd
Myrtle Beach, SC 29588
Phone (843) 293-6606

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1790971927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4884 SOCASTEE BLVD",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887245",
            "telephone_number": "843-293-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4884 SOCASTEE BLVD",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887245",
            "telephone_number": "843-293-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND STRAND FAMILY AND ESTHETIC DENTISTRY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRAND STRAND FAMILY AND ESTHETIC DENTISTRY",
        "enumeration_date": "2007-09-20",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "MACHOWSKI",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "843-293-6606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "2503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9570",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; 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.