Clemson Modern Dentistry, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CLEMSON MODERN DENTISTRY, PC

Doing business as

Clemson Modern Dentistry

Practice address

2708 Clemson Rd Ste a
Columbia, SC 29229-8033

Phone

(803) 830-5972

Fax

(803) 440-8432

NPI assigned

May 3, 2021

Last updated

May 3, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ali Shahrestani, DMD

Title

Owner Dentist

Phone

(714) 845-8890

Specialties & licenses 1

Addresses

Other names 1

• Clemson Modern Dentistry Doing business as

Locations

Practitioners 2

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.

• Ruwaydah Shalash, DDS

  • Dentist
  • Columbia, SC
  • NPI 1396364535
  NPD
• Ann Truong Thai, DMD

  • General Practice Dentistry
  • Columbia, SC
  • NPI 1760167050
  NPD

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620000000000",
    "number": "1811570492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2708 CLEMSON RD STE A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292298033",
            "telephone_number": "803-830-5972",
            "fax_number": "803-440-8432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMSON MODERN DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A",
        "authorized_official_last_name": "SHAHRESTANI",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "714-845-8890",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clemson Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Autumn Hope Clemins, PHARMD
• Anton M Clemmons, M.D.
• Ellen Clemmons
• Jacqueline Rice Clemmons
• Monica Lynnette Clemmons I, COTA/L
• Clemson Sports Medicine and Rehabilitation (Sports Plus)
• Clemson Sports Medicine and Rehabilitation, Inc. (Pinnacle Physical Therapy)
• John Clendenin
• Clergy for Educational Options
• Minnie Maxine Cleveland, RN

• General Practice Dentistry in Columbia, SC
• Providers in Columbia, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; 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.