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).
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
8489 | SC | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| South Carolina Periodontology | Former Legal Business Name - Organization |
| Street Address |
2120 N BELTLINE BLVD |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29204-4518 |
| 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 |
| 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 Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| 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 | ||||
Please comment or provide details below to improve the information on SOUTHERN ROOTS PERIODONTICS: IMPLANT & LASER DENTISTRY, LLC.
| 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.