NPIMap

Organization Active NPI

Creston Dental-1, P.C.

  • General Practice Dentistry
  • Anderson, SC
National Provider Identifier
1972687903
Registry record updated May 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CRESTON DENTAL-1, P.C.
Practice address
3112 N Main St
Anderson, SC 29621-2763
Phone
(678) 904-5665
Fax
(678) 904-5669
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2019

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

Authorized official

Name
Dr. Tu Tran, DDS
Title
President
Phone
(770) 916-9000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X

Addresses

Primary practice location

3112 N Main St
Anderson, SC 29621-2763

Mailing address

1090 Northchase Pkwy SE Ste 150
Marietta, GA 30067-6407
Phone (770) 916-5036

Other names 1

  • Kool Smiles SC, PC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Kool Smiles PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3112 N Main St
Anderson, SC 29621
Phone (803) 590-3054

Practitioners & affiliated clinicians

Practitioners 3

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": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557705600000",
    "number": "1972687903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676407",
            "telephone_number": "770-916-5036",
            "fax_number": "678-285-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3112 N MAIN ST",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296212763",
            "telephone_number": "678-904-5665",
            "fax_number": "678-904-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTON DENTAL-1, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2019-05-13",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "TU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-916-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kool Smiles SC, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Anderson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; 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.