NPIMap

Organization Active NPI

Carolina Park Family Dentistry LLC

Doing business as Carolina Park Family Dentistry

  • Dentist
  • Mount Pleasant, SC
National Provider Identifier
1851906028
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CAROLINA PARK FAMILY DENTISTRY LLC
Doing business as
Carolina Park Family Dentistry
Practice address
3520 Park Avenue Blvd.
Suite 100
Mount Pleasant, SC 29466-2946
Phone
(843) 654-1918
Fax
(843) 654-1917
NPI assigned
Sep 14, 2020
Last updated
Mar 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Authorized official

Name
Dr. Andrew Bellebaum, DMDNPI 1780098723
Title
Owner
Phone
(843) 654-1918

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary
General Practice Dentistry 1223G0001X NU

Addresses

Primary practice location

3520 Park Avenue Blvd.
Suite 100
Mount Pleasant, SC 29466-2946

Mailing address

3520 Park Avenue Blvd.
Suite 100
Mount Pleasant, SC 29466-7567
Phone (843) 654-1918

Other names 1

  • Carolina Park Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

3520 Park Avenue Blvd
Ste 100
Mt Pleasant, SC 29466
Phone (843) 654-1918

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": "1600041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1851906028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 PARK AVENUE BLVD.",
            "address_2": "SUITE 100",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294667567",
            "telephone_number": "843-654-1918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3520 PARK AVENUE BLVD.",
            "address_2": "SUITE 100",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294662946",
            "telephone_number": "843-654-1918",
            "fax_number": "843-654-1917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA PARK FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-14",
        "last_updated": "2021-03-03",
        "certification_date": "2021-02-12",
        "status": "A",
        "authorized_official_last_name": "BELLEBAUM",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-654-1918",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Park Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carolina Park Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Pleasant, SC

Sources for this page

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