Advanced Dermatology and Laser Center P.a.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

13943 Issued in SC

Legal business name

ADVANCED DERMATOLOGY AND LASER CENTER P.A.

Practice address

107 Clair Dr
Piedmont, SC 29673-7771

Phone

(864) 295-3376

Fax

(864) 295-9117

NPI assigned

Sep 24, 2007

Last updated

Sep 7, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ben M Treen, MD

Title

President/Owner

Phone

(864) 295-3376

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315353600000",
    "number": "1942496880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 CLAIR DR",
            "city": "PIEDMONT",
            "state": "SC",
            "postal_code": "296737771",
            "telephone_number": "864-295-3376",
            "fax_number": "864-295-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 CLAIR DR",
            "city": "PIEDMONT",
            "state": "SC",
            "postal_code": "296737771",
            "telephone_number": "864-295-3376",
            "fax_number": "864-295-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY AND LASER CENTER P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2011-09-07",
        "status": "A",
        "authorized_official_last_name": "TREEN",
        "authorized_official_first_name": "BEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "864-295-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SC",
            "license": "13943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139433",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1457466971",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Piedmont, SC
• Providers in Piedmont, SC by specialty
• Dermatology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; 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.