SOUTHERN ROOTS PERIODONTICS: IMPLANT & LASER DENTISTRY, LLC


Address: 2120 N Beltline Blvd, Columbia, SC 29204-4518
Phone: 8037820528

SOUTHERN ROOTS PERIODONTICS: IMPLANT & LASER DENTISTRY, LLC (NPI# 1578009056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1578009056
Entity Type Organization
Organization Name SOUTHERN ROOTS PERIODONTICS: IMPLANT & LASER DENTISTRY, LLC
Other Organization Name SOUTH CAROLINA PERIODONTOLOGY
Practice Address 2120 N Beltline Blvd
Columbia
SC 29204-4518
Practice Telephone 8037820528
Practice Fax Number 8037821036
Mailing Telephone 8037820528
Mailing Fax Number 8037821036
Enumeration Date 2017-01-09
Last Update Date 2017-01-09
Authorized Official Name DR. MATTHEW JOSEPH ROWE (OWNER/MANAGER)
Authorized Official Telephone 8037820528
Authorized Official Credential D.D.S., M.S.D.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QD0000X Clinic/Center
Specialization: Dental
8489 SC Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
South Carolina Periodontology Former Legal Business Name - Organization

Office Location

Street Address 2120 N BELTLINE BLVD
City COLUMBIA
State SC
Zip Code 29204-4518

Providers in the same location

NPI Name Taxonomy Address Enumeration
1134211261 William Cleveland James Jr. Dentist 2120 N Beltline Blvd, Columbia, SC 29204-3905 2006-09-28
1922356997 Matthew Joseph Rowe Dentist 2120 N Beltline Blvd, Ste B, Columbia, SC 29204-4518 2012-08-24

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1992215149 Ricardo Colon II Registered Nurse 3000 Hampton Street, Columbia, SC 29204 2017-10-02
1780113522 Carla Star Noe Registered Nurse Sc Department of Health and Environmental Control, 2100 Bull Street, Collumbia, SC 29204 2017-06-06
1124568514 Kristy L Thompson Nurse Practitioner 1655 Bernardin Ave Ste 240, Columbia, SC 29204 2017-03-03
1982052031 Harold Eugene Cook Iv Podiatrist 1730 St Julian Place, Columbia, SC 29204 2016-05-31
1851748974 Shaquita Banks Counselor 1810 Allen Benedict Ct, A1, Columbia, SC 29204 2016-05-18
1265804835 Premier Care, LLC Case Management 2712 Middleburg Drive, Suite 206, Columbia, SC 29204 2015-10-22
1023492287 Shamiquia N. Mcpherson Counselor 1627 Auburn St., Columbia, SC 29204 2015-07-16
1285028449 The Columbia Free Medical Clinic, Inc. Clinic/Center 1875 Harden Street, Columbia, SC 29204 2015-03-26
1629473459 Leslie Wilson Counselor 2323 Lady Street, Columbia, SC 29204 2014-10-22
1053728683 Candyce Sutton Social Worker 1135 Carter Street, Columbia, SC 29204 2014-07-15
Find all providers in zip 29204

Taxonomy Information

Taxonomy Code 261QD0000X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Dental

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306444740 Ressel Family Dentistry LLC Clinic/Center 1 E Broadway Ste A, Columbia, MO 65203-4205 2020-10-16
1578175733 Columbia Dental LLC Clinic/Center 846 Lancaster Ave, Columbia, PA 17512-2206 2020-08-19
1386256931 B. Casey Crafton Dds Ms PC Clinic/Center 10380 Old Columbia Rd, Columbia, MD 21046-1882 2020-08-17
1497307730 Robert C Wilhite Jr Dds Pllc Clinic/Center 1300 Hatcher Ln Ste 1, Columbia, TN 38401-3554 2019-07-16
1609335066 Dentistry for Children of Maryland, LLC Clinic/Center 8600 Snowden River Pkwy Ste 302, Columbia, MD 21045-1985 2019-03-15
1407314404 Dental Wellness Center of Irmo, LLC Clinic/Center 2724 N Lake Dr Ste 304, Columbia, SC 29212-8733 2019-03-08
1386101459 Columbia Dental Health Clinic Clinic/Center 2750 Laurel St Ste 202, Columbia, SC 29204-2024 2019-02-26
1821580622 Columbia Smiles Downtown Clinic/Center 1310 Lady St Ste 600, Columbia, SC 29201-3327 2018-06-06
1427548353 Simply Smile Pa Clinic/Center 7457 Patterson Rd Ste 107, Columbia, SC 29209-0710 2018-05-16
1477055481 Southern Smiles Dental Studio Columbia LLC Clinic/Center 160 Summit Centre Dr, Columbia, SC 29229-7612 2018-03-06
Find all providers in COLUMBIA

Competitor

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City COLUMBIA
Zip Code 29204

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Dataset Information

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.

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