NPIMap

Organization Active NPI

Southern Oak Dental, LLC

  • General Practice Dentistry
  • Myrtle Beach, SC
National Provider Identifier
1891326617
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SOUTHERN OAK DENTAL, LLC
Practice address
1017 Highway 501
Myrtle Beach, SC 29577-3820
Phone
(843) 492-4080
NPI assigned
Jan 30, 2020
Last updated
Jan 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Authorized official

Name
Mr. Frank Gong
Title
Owner
Phone
(206) 371-2940

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

1017 Highway 501
Myrtle Beach, SC 29577-3820

Mailing address

4921 Centre Pointe Dr Ste 201
North Charleston, SC 29418-6997
Phone (843) 929-1200

National Provider Directory

National Provider Directory
Tax ID family
Southern Oak Dental LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1017 Highway 501
Myrtle Beach, SC 29577
Phone (843) 492-4080

NPI Registry JSON

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1891326617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 CENTRE POINTE DR STE 201",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294186997",
            "telephone_number": "843-929-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 HIGHWAY 501",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295773820",
            "telephone_number": "843-492-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OAK DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-30",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "GONG",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-371-2940",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; 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.