SOUTHERN OAK DENTAL, LLC (NPI# 1497225916) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497225916 |
| Entity Type | Organization |
| Organization Name | SOUTHERN OAK DENTAL, LLC |
| Practice Address |
2676 Church St Unit A Conway SC 29526-4471 |
| Mailing Address |
4921 Centre Pointe Dr Ste 201 N Charleston SC 29418-6997 |
| Practice Telephone | 8433313237 |
| Mailing Telephone | 8439091299 |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2020-01-30 |
| Authorized Official Name | MR. FRANK GONG (OWNER) |
| Authorized Official Telephone | 2063712516 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336761097 | Southern Oak Dental, LLC | Dentist | 1322 Broad St Unit 90, Sumter, SC 29150-1984 | 2020-05-15 |
| 1891326617 | Southern Oak Dental, LLC | Dentist | 1017 Highway 501, Myrtle Beach, SC 29577-3820 | 2020-01-30 |
| 1811459159 | Southern Oak Dental, LLC | Dentist | 101 Verdae Blvd Ste 201, Greenville, SC 29607-3832 | 2019-04-04 |
| 1295204279 | Southern Oak Dental, LLC | Dentist | 4921 Centre Pointe Dr Ste 201, N Charleston, SC 29418-6997 | 2018-11-19 |
| 1427510767 | Southern Oak Dental, LLC | Dentist | 2127 E Main St, Spartanburg, SC 29307-1454 | 2019-04-04 |
| 1518436591 | Southern Oak Dental, LLC | Dentist | 19 Towne Dr, Bluffton, SC 29910-4201 | 2018-11-19 |
| Street Address |
2676 CHURCH ST UNIT A |
| City | CONWAY |
| State | SC |
| Zip Code | 29526-4471 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487131793 | Jimiskumar Satishkumar Patel | Dentist | 2676 Church St Unit A, Conway, SC 29526-4471 | 2018-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457975237 | Terri L Champion | Massage Therapist | 172 Waccamaw Medical Park Court, Conway, SC 29526 | 2020-06-08 |
| 1689204398 | Alayna Defalco | Clinical Exercise Physiologist | 1320 501 Business, Unit E, Conway, SC 29526 | 2020-01-22 |
| 1124672662 | Proxsys Rx - Sc, LLC | Pharmacy | 300 Singelton Ridge Road, Conway, SC 29526 | 2019-08-01 |
| 1598227431 | Surgery Center of Conway Inc | Clinic/Center | 1405 Main Street, Conway, SC 29526 | 2019-04-01 |
| 1801374962 | Trevor James Hess | Specialist/Technologist | 905 One Landon Loop, Conway, SC 29526 | 2018-08-01 |
| 1851800817 | Katherine Ann Nimphius | Behavioral Analyst | 105 Timberline Dr, Conway, SC 29526 | 2017-09-21 |
| 1922544253 | William Houck | Specialist/Technologist | 925 One Landon Loop, Conway, SC 29526 | 2017-01-10 |
| 1952857278 | Courtney Jeanette Smith | Counselor | 164 Waccamaw Medical Park Dr., Conway, SC 29526 | 2016-08-28 |
| 1336502632 | Jebediah S. Christy, D.d.s - Conway, Pllc | Dentist | 2756 Church St, Conway, SC 29526 | 2016-04-04 |
| 1447615208 | Abl Enterprises, LLC | Optometrist | 113 Citadel Drive, Conway, SC 29526 | 2015-12-22 |
| Find all providers in zip 29526 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497310288 | Luke Fruchey | Dentist | 1125 S Amity Rd, Conway, AR 72032-8090 | 2019-05-07 |
| 1821591876 | Randy Lenderman Dds Plc | Dentist | 2425 Prince St Ste 1, Conway, AR 72034-3701 | 2018-03-15 |
| 1275035602 | Conway Dental Center Pllc | Dentist | 1600 E. Oak Street Suite B, Conway, AR 72032 | 2018-03-01 |
| 1427592732 | Axpm- Conway Dental Pllc | Dentist | 8 Medical Ln, Conway, AR 72034-4913 | 2016-12-06 |
| 1336502632 | Jebediah S. Christy, D.d.s - Conway, Pllc | Dentist | 2756 Church St, Conway, SC 29526 | 2016-04-04 |
| 1548642556 | Brooke Jeffus, Dds, Pllc | Dentist | 2235 Dave Ward Dr Ste 103, Conway, AR 72034-7040 | 2015-06-25 |
| 1316326028 | Jacob Seiter | Dentist | 2157 Prince St, Conway, AR 72034-3737 | 2015-05-27 |
| 1083032379 | East Oak Dental Pa | Dentist | 1600 E Oak St, Ste B, Conway, AR 72032 | 2014-04-03 |
| 1669800421 | Kidz Choice Conway LLC | Dentist | 2415 Prince St, Suite 105, Conway, AR 72034-3746 | 2013-10-14 |
| 1962782961 | Michael J Maser | Dentist | 1867 Highway 544 Unit B, Conway, SC 29526-8478 | 2011-08-22 |
| Find all providers in CONWAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.