Family Dental Health of Oakbrook

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FAMILY DENTAL HEALTH OF OAKBROOK

Practice address

101 Morgan PL
Summerville, SC 29485-8106

Phone

(843) 851-2951

NPI assigned

May 25, 2022

Organization subpart

Yes

Parent organization

FDH HOLDINGSAs reported in NPPES

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

Authorized official

Name

Mrs. Beth Illsley

Title

Directory of Insurance

Phone

(864) 282-1935

Specialties & licenses 1

Addresses

Other names 3

• Family Dental Health of Goose Creek Doing business as
• Family Dental Health of Oakbrook LLC Doing business as
• Family Dental Health of Tobias Gadson LLC 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.

• Matthew Michael Willis, DMD

  • General Practice Dentistry
  • Summerville, SC
  • NPI 1043949779
  NPD
• Keenan W. Green, D.M.D

  • General Practice Dentistry
  • Summerville, SC
  • NPI 1497825400
  NPD (past)

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1841938263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MEMORIAL DRIVE EXT STE 400",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296511850",
            "telephone_number": "864-282-1935",
            "fax_number": "864-751-6387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MORGAN PL",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294858106",
            "telephone_number": "843-851-2951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "129 Plantation North Blvd Ste D",
            "address_purpose": "LOCATION",
            "city": "Goose Creek",
            "state": "SC",
            "postal_code": "294455776",
            "country_code": "US",
            "telephone_number": "803-410-4920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1470 Tobias Gadson Blvd Ste 100B",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294074835",
            "country_code": "US",
            "telephone_number": "843-556-9939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY DENTAL HEALTH OF OAKBROOK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FDH HOLDINGS",
        "enumeration_date": "2022-05-25",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "ILLSLEY",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "DIRECTORY OF INSURANCE",
        "authorized_official_telephone_number": "864-282-1935",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Dental Health of Goose Creek",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Dental Health of Oakbrook LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Dental Health of Oakbrook LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Dental Health of Tobias Gadson LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Goodness Ezeanyaso, M.D.
• Tessa Daniel Fach, NP
• Jennifer Ivey Fahey, PHARMD
• Faithful Companion Home Care,LLC
• Tedd Joseph Falk, DPT
• Family Engagement & Support Services
• Family Orthodontics of S. Carolina, LLC
• Isabella Fannin, PHARMD
• Chandler Farrell, DC
• Madison Farrell III, PHD, LPC

• General Practice Dentistry in Summerville, SC
• Providers in Summerville, 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 1, 2023; 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.