NPIMap

Organization Active NPI

Ivy Creek Family Dentistry LLC

  • General Practice Dentistry
  • Columbia, SC
National Provider Identifier
1962033001
Registry record updated Jan 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
IVY CREEK FAMILY DENTISTRY LLC
Practice address
9007 Two Notch Rd Ste B
Columbia, SC 29223-5834
Phone
(803) 302-4445
NPI assigned
Jan 28, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2020

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

Authorized official

Name
Dr. Chermaine Latrice Lyde, DMDNPI 1689830226
Title
Owner/Partner
Phone
(803) 302-4445

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

9007 Two Notch Rd Ste B
Columbia, SC 29223-5834

Mailing address

337 Oakpointe LN
Lexington, SC 29072-7232
Phone (912) 695-8540

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL pending

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1580169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580169600000",
    "number": "1962033001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 OAKPOINTE LN",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290727232",
            "telephone_number": "912-695-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9007 TWO NOTCH RD STE B",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292235834",
            "telephone_number": "803-302-4445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-28",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A",
        "authorized_official_last_name": "LYDE",
        "authorized_official_first_name": "CHERMAINE",
        "authorized_official_middle_name": "LATRICE",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "803-302-4445",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "pending",
            "affiliation": "N",
            "endpointDescription": "pending, website and network are currently in progress of being set up",
            "address_1": "9007 Two Notch Rd Ste B",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292235834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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 Jan 28, 2020; 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.