Active NPI
Gordon W Womack, DDS
- Pediatric Dentistry
- Hanahan, SC
National Provider Identifier
1972600989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DGD.2025DS
- Practice address
- 996 Tanner Ford Blvd
Hanahan, SC 29410-4780 - Phone
- (843) 212-8810
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DGD.9455GD | SC | |
| Dentist | 122300000X | 17287 | OH | |
| Pediatric Dentistry | 1223P0221X | 17287 | OH | |
| Pediatric Dentistry | 1223P0221X | DGD.2025DS | SC | Primary |
Addresses
Primary practice location
996 Tanner Ford Blvd
Hanahan, SC 29410-4780
Mailing address
102 View St
Moncks Corner, SC 29461-9783
Phone (843) 214-8040
Other practice location 1
3300 Kemp Rd
Beavercreek, OH 45431-4200
Phone (937) 426-2653
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0617587 | Medicaid | OH | |
| 311367412 | Other | OH | FED TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DGD.9455GD | SC | MD | Dentist |
| 17287 | OH | MD | Pediatric Dentist |
| DGD.2025DS | SC | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731974400000",
"number": "1972600989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 VIEW ST",
"city": "MONCKS CORNER",
"state": "SC",
"postal_code": "294619783",
"telephone_number": "843-214-8040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "996 TANNER FORD BLVD",
"city": "HANAHAN",
"state": "SC",
"postal_code": "294104780",
"telephone_number": "843-212-8810"
}
],
"practiceLocations": [
{
"address_1": "3300 Kemp Rd",
"address_purpose": "LOCATION",
"city": "Beavercreek",
"state": "OH",
"postal_code": "454314200",
"country_code": "US",
"telephone_number": "937-426-2653",
"fax_number": "937-426-1124",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WOMACK",
"first_name": "GORDON",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2024-11-19",
"certification_date": "2024-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "DGD.9455GD",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "17287",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OH",
"license": "17287",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "SC",
"license": "DGD.2025DS",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0617587",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FED TAX ID",
"identifier": "311367412",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hanahan, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.