Grover Edens Rabon, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3460 Issued in SC

Practice address

669B West Wesmark Blvd
Sumter, SC 29150

Phone

(803) 905-3567

Fax

(803) 905-3507

NPI assigned

Dec 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Restorative Arts Dental PA

  • Durable Medical Equipment & Medical Supplies
  • Sumter, SC
  • NPI 1851095053
  NPD (past) Authorized official
• Restorative Arts Dental PA

  • Public Health Dentistry
  • Sumter, SC
  • NPI 1043962186
  NPD (past)

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922164706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "669B WEST WESMARK BLVD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "29150",
            "telephone_number": "803-905-3567",
            "fax_number": "803-905-3507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "669B WEST WESMARK BLVD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "29150",
            "telephone_number": "803-905-3567",
            "fax_number": "803-905-3507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RABON",
        "first_name": "GROVER",
        "middle_name": "EDENS",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3460",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam Gregory Przybyla, M.D.
• Anna Crew Kinney Psomas, CNM, WHNP-BC
• PSW Homecare LLC
• Evan Queen, PTA
• Bronwyn T. Rabon
• James Keith Rabon, DMD
• Ragin Wellness Center LLC
• Anidra Tiana Ragin
• Valerie B. Ragin, LPC
• Brittany Ramsey

• General Practice Dentistry in Sumter, SC
• Providers in Sumter, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.