NPIMap

Organization Active NPI

Dental Professionals of South Carolina, P.C.

Doing business as Devine Dentistry

  • General Practice Dentistry
  • Columbia, SC
National Provider Identifier
1942668199
Registry record updated Feb 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Doing business as
Devine Dentistry
Practice address
621 Chatham Ave
Columbia, SC 29205-2734
Phone
(803) 256-1817
NPI assigned
Feb 3, 2016
Last updated
Feb 3, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 3, 2016

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

Authorized official

Name
Heater Pruemer
Title
Credentialing Team Lead
Phone
(217) 540-8434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

621 Chatham Ave
Columbia, SC 29205-2734

Mailing address

621 Chatham Ave
Columbia, SC 29205-2734

Other names 1

  • Devine Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of SC PC74 organizations share this tax ID, including this one
Part of
Dental Professionals of SC PC

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

Locations

621 Chatham Ave
Columbia, SC 29205
Phone (803) 256-1817

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454457600000",
    "number": "1942668199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 CHATHAM AVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292052734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 CHATHAM AVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292052734",
            "telephone_number": "803-256-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.",
        "enumeration_date": "2016-02-03",
        "last_updated": "2016-02-03",
        "status": "A",
        "authorized_official_last_name": "PRUEMER",
        "authorized_official_first_name": "HEATER",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8434"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Devine Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; 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.