NPIMap

Organization Active NPI

Modern Legacy, Inc.

  • General Practice Dentistry
  • Latta, SC
National Provider Identifier
1992032486
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN LEGACY, INC.
Practice address
203 S Marion St
Latta, SC 29565-1522
Phone
(843) 752-7655
Fax
(843) 752-4500
NPI assigned
Nov 4, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Jachelle Ag Sprattling, DMDNPI 1659489003
Title
Secretary
Phone
(843) 810-4259

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 MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

203 S Marion St
Latta, SC 29565-1522

Mailing address

203 S Marion St
Latta, SC 29565-1522
Phone (843) 752-7655

Other names 1

  • Latta Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1257292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1992032486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 S MARION ST",
            "city": "LATTA",
            "state": "SC",
            "postal_code": "295651522",
            "telephone_number": "843-752-7655",
            "fax_number": "843-752-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S MARION ST",
            "city": "LATTA",
            "state": "SC",
            "postal_code": "295651522",
            "telephone_number": "843-752-7655",
            "fax_number": "843-752-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN LEGACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-04",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "SPRATTLING",
        "authorized_official_first_name": "JACHELLE",
        "authorized_official_middle_name": "AG",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "843-810-4259",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Latta Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Latta, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.

Verify at the official NPI Registry.