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1164304986 NPI number — PREMIER SMILE CENTER

NPI Number: 1164304986
Health Care Provider/Practitioner: PREMIER SMILE CENTER

Information about “1164304986” NPI (PREMIER SMILE CENTER) exists in 1164304986 in HTML format HTML  |  1164304986 in plain Text format TXT  |  1164304986 in PDF (Portable Document Format) PDF  |  1164304986 in an XML format XML  formats.

NPI Number : 1164304986 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164304986",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "SMITH, GLENNELL",
    "ParentOrgTIN": null,
    "OrgName": "PREMIER SMILE CENTER",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7212 BROOKFIELD RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29223-2202",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7212 BROOKFIELD RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29223-2202",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "803-626-1265",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/23/2025",
    "LastUpdateDate": "07/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SMITH",
    "AuthorizedOfficialFirstName": "GLENNELL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DENTIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DDS",
    "AuthorizedOfficialTelephoneNumber": "803-626-1265",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "332BC3200X",
        "TaxonomyName": "Customized Equipment (DME)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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