NPIMap

Organization Active NPI

Issaqueena Pediatric Dentistry P.a.

  • Pediatric Dentistry
  • Seneca, SC
National Provider Identifier
1992056378
Registry record updated Sep 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4211 Issued in SC
Legal business name
ISSAQUEENA PEDIATRIC DENTISTRY P.A.
Practice address
314 Union Station Dr
Seneca, SC 29678-4547
Phone
(864) 482-7900
Fax
(864) 482-7510
NPI assigned
Sep 26, 2012
Last updated
Sep 26, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2012

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

Authorized official

Name
Dr. Camille W Horton, DMDNPI 1588875934
Title
President
Phone
(864) 482-7900

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 4211 SC Primary

Addresses

Primary practice location

314 Union Station Dr
Seneca, SC 29678-4547

Mailing address

314 Union Station Dr
Seneca, SC 29678-4547
Phone (864) 482-7900

Other identifiers 1

IdentifierTypeStateIssuer
1588875934MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Issaqueena Pediatric Dentistry PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1348617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348617600000",
    "number": "1992056378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 UNION STATION DR",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296784547",
            "telephone_number": "864-482-7900",
            "fax_number": "864-482-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 UNION STATION DR",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296784547",
            "telephone_number": "864-482-7900",
            "fax_number": "864-482-7510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISSAQUEENA PEDIATRIC DENTISTRY P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-26",
        "last_updated": "2012-09-26",
        "status": "A",
        "authorized_official_last_name": "HORTON",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-482-7900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "4211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588875934",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seneca, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; 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.