NPIMap

Organization Active NPI

Southern Oak Dental, LLC

  • General Practice Dentistry
  • Greenville, SC
National Provider Identifier
1811459159
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SOUTHERN OAK DENTAL, LLC
Practice address
101 Verdae Blvd Ste 201
Greenville, SC 29607-3832
Phone
(864) 587-7155
NPI assigned
Apr 4, 2019
Last updated
Jan 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Authorized official

Name
Mr. Frank Gong
Title
Owner
Phone
(206) 371-2940

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

101 Verdae Blvd Ste 201
Greenville, SC 29607-3832

Mailing address

4921 Centre Pointe Dr Ste 201
N Charleston, SC 29418-6997
Phone (843) 459-8780

National Provider Directory

National Provider Directory
Tax ID family
Southern Oak Dental LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

101 Verdae Blvd
Ste 201
Greenville, SC 29607
Phone (864) 587-7155

NPI Registry JSON

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

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1811459159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 CENTRE POINTE DR STE 201",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294186997",
            "telephone_number": "843-459-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 VERDAE BLVD STE 201",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296073832",
            "telephone_number": "864-587-7155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OAK DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-04",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "GONG",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-371-2940",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; 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.