Edgar H Peacock, Jr, DDS, PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1545/OS161 Issued in SC

Legal business name

EDGAR H PEACOCK, JR, DDS, PA

Practice address

2750 Laurel St
Suite 202
Columbia, SC 29204-2038

Phone

(803) 256-9268

Fax

(803) 256-0084

NPI assigned

Jan 14, 2008

Last updated

Jan 14, 2008By 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. Edgar Harold Peacock Jr., D. D. SNPI 1275536245

Title

President

Phone

(803) 256-9268

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

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.

• Edgar Harold Peacock Jr., D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbia, SC
  • NPI 1275536245
  Authorized official Same address or phone

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1952587644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 LAUREL ST",
            "address_2": "SUITE 202",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042038",
            "telephone_number": "803-256-9268",
            "fax_number": "803-256-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 LAUREL ST",
            "address_2": "SUITE 202",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042038",
            "telephone_number": "803-256-9268",
            "fax_number": "803-256-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGAR H PEACOCK, JR, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "PEACOCK",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-256-9268",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D. D. S"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "1545/OS161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9549",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z15458",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Adam Edelson, MD
• Eden Health Solutions LLC
• Amanda Eden, FNP-C
• Margaret J. Edens, CRNA
• Kim Beth Edford-Davis, DO
• Samantha Edge
• Dionne Edmond-Dunn
• Bradley Scott Edmonds, MD
• Henry Leon Edmonds Jr.
• Layla Marie Edmonds, LMT

• Oral and Maxillofacial Surgery (Dentist) in Columbia, SC
• Providers in Columbia, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; 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.