Southeast Endodontics, PC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

3707 Issued in SC

Legal business name

SOUTHEAST ENDODONTICS, PC

Practice address

10 Farmfield Ave
Charleston, SC 29407-7756

Phone

(843) 766-0112

Fax

(843) 766-0884

NPI assigned

May 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Walter R. Long, D.M.D.

Title

Owner

Phone

(843) 766-0112

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902019722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 E FARMFIELD AVENUE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29407",
            "telephone_number": "843-766-0112",
            "fax_number": "843-766-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 FARMFIELD AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077756",
            "telephone_number": "843-766-0112",
            "fax_number": "843-766-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ENDODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-766-0112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "SC",
            "license": "3707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colton Southard-Goebel, MD
• Bailey Southard, PHARMD
• Kinsey Knight Southard, PA-C
• Molly Mae Southard, RN
• Southeast Cardiology
• Southeast Wound Specialists, LLC
• Southeastern Facial Plastic Cosmetic Surgery Center, P.a.
• Southern Home Care Services, Inc.
• William M Southgate, MD
• Douglas B Southworth, MD

• All providers in Charleston, SC
• Endodontics in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.