NPIMap

Organization Active NPI

Elite Smiles Dental, P.a.

  • Dentist
  • Columbia, SC
National Provider Identifier
1861649386
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3794 Issued in SC
Legal business name
ELITE SMILES DENTAL, P.A.
Practice address
9020 Farrow Rd
Columbia, SC 29203-9773
Phone
(803) 419-5002
Fax
(803) 419-9600
NPI assigned
Aug 27, 2008
Last updated
Feb 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

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

Authorized official

Name
Andrew G Gambrell, D.M.DNPI 1730220112
Title
General Dentist
Phone
(803) 419-5002

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X SC2116 SC
Dentist 122300000X 30-04295 SC
Dentist 122300000X 2116 SC
Dentist 122300000X 3794 SC Primary
General Practice Dentistry 1223G0001X 03794 SC

Addresses

Primary practice location

9020 Farrow Rd
Columbia, SC 29203-9773

Mailing address

9020 Farrow Rd
Columbia, SC 29203-9773
Phone (803) 419-5002

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487635200000",
    "number": "1861649386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9020 FARROW RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039773",
            "telephone_number": "803-419-5002",
            "fax_number": "803-419-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9020 FARROW RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039773",
            "telephone_number": "803-419-5002",
            "fax_number": "803-419-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE SMILES DENTAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-27",
        "last_updated": "2017-02-21",
        "status": "A",
        "authorized_official_last_name": "GAMBRELL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "803-419-5002",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "SC2116",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "30-04295",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "2116",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "3794",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "03794",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; 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.