NPIMap

Organization Active NPI

Edisto Dental Associates LLC

  • General Practice Dentistry
  • Orangeburg, SC
National Provider Identifier
1871779413
Registry record updated Jan 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4010 Issued in SC
Legal business name
EDISTO DENTAL ASSOCIATES LLC
Practice address
2197 Saint Matthews Rd
Orangeburg, SC 29118-2038
Phone
(803) 531-1601
NPI assigned
Jan 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2008

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

Authorized official

Name
Dr. Clifton Jordan III, DDSNPI 1083662415
Title
Owner/Dentist
Phone
(803) 531-1601

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 4010 SC Primary

Addresses

Primary practice location

2197 Saint Matthews Rd
Orangeburg, SC 29118-2038

Mailing address

2197 St. Matthew Road
Orangeburg, SC 29118
Phone (803) 531-1601

National Provider Directory

National Provider Directory

Locations

2197 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 531-1601

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1871779413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2197 ST. MATTHEW ROAD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "29118",
            "telephone_number": "803-531-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2197 SAINT MATTHEWS RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291182038",
            "telephone_number": "803-531-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISTO DENTAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "CLIFTON",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "803-531-1601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orangeburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; 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.