NPIMap

Organization Active NPI

Palmetto Family Dentistry of Anderson, LLC

  • Dentist
  • Anderson, SC
National Provider Identifier
1811377120
Registry record updated Jun 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3611 Issued in SC
Legal business name
PALMETTO FAMILY DENTISTRY OF ANDERSON, LLC
Practice address
2713 N Main St
Anderson, SC 29621-3282
Phone
(864) 226-8272
Fax
(864) 964-9538
NPI assigned
Jun 2, 2015
Last updated
Jun 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2015

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

Authorized official

Name
Dr. Jason Christopher Mitchell, DMDNPI 1376752261
Title
President
Phone
(864) 226-8272

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4399 SC
Dentist 122300000X 3611 SC Primary

Addresses

Primary practice location

2713 N Main St
Anderson, SC 29621-3282

Mailing address

2713 N Main St
Anderson, SC 29621-3282
Phone (864) 226-8272

Other identifiers 1

IdentifierTypeStateIssuer
ZA9700MedicaidSC

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1811377120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2713 N MAIN ST",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296213282",
            "telephone_number": "864-226-8272",
            "fax_number": "864-964-9538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2713 N MAIN ST",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296213282",
            "telephone_number": "864-226-8272",
            "fax_number": "864-964-9538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO FAMILY DENTISTRY OF ANDERSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-02",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-226-8272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "4399",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "3611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9700",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; 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.