DISTINCTIVE DENTISTRY (NPI# 1760664304) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760664304 |
| Entity Type | Organization |
| Organization Name | DISTINCTIVE DENTISTRY |
| Practice Address |
11107 Broad River Rd Suite D Irmo SC 29063-7602 |
| Practice Telephone | 8037493980 |
| Practice Fax Number | 8037493981 |
| Mailing Telephone | 8037493980 |
| Mailing Fax Number | 8037493981 |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2007-12-05 |
| Authorized Official Name | DR. ROBERT RAY CUNNINGHAM JR. (OWNER) |
| Authorized Official Telephone | 8039176962 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
4114 | SC | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063649549 | Distinctive Dentistry | Dentist | 595 Putnam Pike, Greenville, RI 02828-2137 | 2009-06-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | DISTINCTIVE DENTISTRY | 13110 Se Sunnyside Road, Clackamas, OR 97015 |
| Oregon Corporations, Companies and Business Names | DISTINCTIVE DENTISTRY OF BEND | 225 Sw Scalehouse Lp Ste 101, Bend, OR 97702 |
| Oregon Corporations, Companies and Business Names | DISTINCTIVE DENTISTRY OF BURNS | 711 Ponderosa Village, Burns, OR 97720 |
| Oregon Corporations, Companies and Business Names | DISTINCTIVE DENTISTRY OF EUGENE | 1775 River Rd, Eugene, OR 97404 |
| Oregon Corporations, Companies and Business Names | DISTINCTIVE DENTISTRY OF OREGON | 1775 River Rd, Eugene, OR 97404 |
| Street Address |
11107 BROAD RIVER RD SUITE D |
| City | IRMO |
| State | SC |
| Zip Code | 29063-7602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720603640 | Daniel Witcher | Counselor | 1180 Columbia Avenue, Suite 203, Irmo, SC 29063 | 2020-06-16 |
| 1710512140 | Arie Anew Services Incorporated | Psychologist | 7803 St. Andrews Road, C5, Irmo, SC 29063 | 2020-03-05 |
| 1366922296 | Jennie C Beym | Speech-Language Pathologist | 7 Tip Top Court, Irmo, SC 29063 | 2018-08-20 |
| 1295214088 | The Well LLC | Massage Therapist | 1720 Dutch Fork Rd., Irmo, SC 29063 | 2018-08-13 |
| 1699268821 | Shannon Marie Kelly | Dentist | 200 N Royal Tower Dr, Irmo, SC 29063 | 2018-06-12 |
| 1497243174 | Anthony Batiste Thompson Jr. | Behavior Technician | 137 Chapelwhite Road, Irmo, SC 29063 | 2018-04-27 |
| 1578076022 | Demario Sawyer Sr | Ambulance | 107 N Royal Tower Dr Ste C, Irmo, SC 29063 | 2017-11-07 |
| 1306365713 | Dreher Shuler | Student in an Organized Health Care Education/Training Program | 205 River Creek Drive, Irmo, SC 29063 | 2017-09-18 |
| 1053833442 | Tania Rodriguez | Social Worker | 30 Ash Court, Irmo, SC 29063 | 2017-07-07 |
| 1598294944 | Ashley Elaine Bradley | Home Health | 120 Stockland Rd, Irmo, SC 29063 | 2017-06-08 |
| Find all providers in zip 29063 | ||||
| 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 |
|---|---|---|---|---|
| 1699268821 | Shannon Marie Kelly | Dentist | 200 N Royal Tower Dr, Irmo, SC 29063 | 2018-06-12 |
| 1730619495 | Joshua Fulton | Dentist | 7897 Broad River Rd, Irmo, SC 29063-2357 | 2017-06-15 |
| 1215399977 | Kelcy Ann Huddle | Dentist | 7241 Broad River Rd Ste 90, Irmo, SC 29063-8164 | 2016-03-22 |
| 1225419930 | Patrick William Orman Iv | Dentist | 7210 Broad River Rd Ste N, Irmo, SC 29063-8150 | 2015-06-18 |
| 1144534223 | Allen Crosby Livingston Jr. | Dentist | 1028 Kinley Road, Irmo, SC 29063-9632 | 2010-08-02 |
| 1417100371 | Childrens Dental Group of South Carolina | Dentist | 7210k Broad River Rd, Irmo, SC 29063-7973 | 2008-10-23 |
| 1619139482 | Sherry Benenhaley Rauch | Dentist | 7436 Broad River Rd, Suite 111, Irmo, SC 29063-7601 | 2008-07-01 |
| 1255463808 | A. Crosby Livingston, Jr., Dmd, Pa | Dentist | 1028 Kinley Rd, Irmo, SC 29063-9632 | 2007-03-09 |
| 1992849624 | Gregory Joseph Wych | Dentist | 7505 Saint Andrews Rd, Irmo, SC 29063 | 2007-02-16 |
| 1043350507 | Michelle Lynne Mistele | Dentist | 3533 Dreher Shoals Rd, Irmo, SC 29063-9115 | 2007-02-07 |
| Find all providers in IRMO | ||||
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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.