NPIMap

Organization Active NPI

Welvista

  • General Practice Dentistry
  • Dillon, SC
National Provider Identifier
1922189885
Registry record updated Sep 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WELVISTA
Doing business as
Dillon Two Smiles for a Lifetime
Practice address
1730A Highway 301 N
Dillon, SC 29536-1950
Phone
(843) 774-6200
Fax
(843) 774-6283
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2017

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

Authorized official

Name
Mrs. Georgia Bennett Famuliner
Title
Operations Driector
Phone
(803) 584-4803

Specialties & licenses 1

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

Addresses

Primary practice location

1730A Highway 301 N
Dillon, SC 29536-1950

Mailing address

PO Box 1502
Dillon, SC 29536-1502
Phone (843) 774-6200

Other identifiers 1

IdentifierTypeStateIssuer
ZA9609MedicaidSC

Other names 1

  • Dillon Two Smiles for a Lifetime Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Welvista7 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

1730A Highway 301 N
Dillon, SC 29536
Phone (843) 774-6200

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505865600000",
    "number": "1922189885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1502",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295361502",
            "telephone_number": "843-774-6200",
            "fax_number": "843-774-6283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730A HIGHWAY 301 N",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295361950",
            "telephone_number": "843-774-6200",
            "fax_number": "843-774-6283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELVISTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2017-09-20",
        "status": "A",
        "authorized_official_last_name": "FAMULINER",
        "authorized_official_first_name": "GEORGIA",
        "authorized_official_middle_name": "BENNETT",
        "authorized_official_title_or_position": "OPERATIONS DRIECTOR",
        "authorized_official_telephone_number": "803-584-4803",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9609",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dillon Two Smiles for a Lifetime",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dillon, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.