Medicaid Dental Practice of Easley, SC, Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3944 Issued in SC

Legal business name

MEDICAID DENTAL PRACTICE OF EASLEY, SC, INC

Practice address

807 S Pendleton St
Easley, SC 29640-3527

Phone

(864) 855-6530

NPI assigned

Jul 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Shawn C Edwards, DDS

Title

President

Phone

(864) 859-0111

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185408000000",
    "number": "1932399862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S PENDLETON ST",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296403072",
            "telephone_number": "864-859-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 S PENDLETON ST",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296403527",
            "telephone_number": "864-855-6530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAID DENTAL PRACTICE OF EASLEY, SC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2007-07-26",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-859-0111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian McGuckian
• David M. McInnis, D.M.D.
• Helen Elaina McMahan, DPT
• Hailee McWhorter
• Valerie Lane Meador, RD
• Medical Center Inc. of Pickens
• Medmonitor Clinic LLC
• Kay Motz Melba, APRN
• Michael Mequio, M.D.
• Phyllis B Merck, RN

• General Practice Dentistry in Easley, SC
• Providers in Easley, 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 26, 2007; 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.