NPIMap

Organization Active NPI

Dental Professionals of South Carolina, PC

Doing business as Eastside General Dentistry

  • General Practice Dentistry
  • Spartanburg, SC
National Provider Identifier
1972894251
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF SOUTH CAROLINA, PC
Doing business as
Eastside General Dentistry
Practice address
2445 E Main St
Spartanburg, SC 29307-1415
Phone
(864) 579-7833
Fax
(864) 590-5364
NPI assigned
Apr 21, 2011
Last updated
Apr 21, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF SOUTH CAROLINA, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

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

Authorized official

Name
Kam Shick
Title
Insurance Coordinator
Phone
(217) 540-5141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

2445 E Main St
Spartanburg, SC 29307-1415

Mailing address

2445 E Main St
Spartanburg, SC 29307-1415
Phone (864) 579-7833

Other names 1

  • Eastside General Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of South Carolina74 organizations share this tax ID, including this one
Part of
Dental Professionals of South Carolina

Organizations with this tax ID in the same state 15

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

View all 15

Locations

2445 E Main St
Spartanburg, SC 29307
Phone (864) 579-7833

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1303344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303344000000",
    "number": "1972894251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2445 E MAIN ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071415",
            "telephone_number": "864-579-7833",
            "fax_number": "864-590-5364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2445 E MAIN ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071415",
            "telephone_number": "864-579-7833",
            "fax_number": "864-590-5364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF SOUTH CAROLINA, PC",
        "enumeration_date": "2011-04-21",
        "last_updated": "2011-04-21",
        "status": "A",
        "authorized_official_last_name": "SHICK",
        "authorized_official_first_name": "KAM",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "217-540-5141"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside General Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; 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.