SUMTER ORAL & MAXILLOFACIAL SURGERY PA NPI 1083677884

NPI Information

NPI: 1083677884
Provider Name: SUMTER ORAL & MAXILLOFACIAL SURGERY PA
Classification: Dentist - 1223S0112X
Specialization: Oral and Maxillofacial Surgery
Entity Type: Organization
Doing Business As: DENTAL IMPLANT CENTER OF SUMTER
Address: 1210 WILSON HALL RD
SUMTER, SC
ZIP 29150
Phone: (803) 905-4404

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NPI Details

SUMTER ORAL & MAXILLOFACIAL SURGERY PA is an oral and maxillofacial surgery dentist in Sumter, SC. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. SUMTER ORAL & MAXILLOFACIAL SURGERY PA NPI is 1083677884. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Dental Implant Center Of Sumter.

The provider's business location address is:

1210 WILSON HALL RD
SUMTER, SC
ZIP 29150-889
Phone: (803) 905-4404
Fax: (803) 905-4406

The provider's authorized official is Michael A Mcginnis .
The authorized official title is Owner and has the following contact phone number (803) 905-4404.

The enumeration date for this NPI number is 4/11/2006 and was last updated on 1/14/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	122300000X	Dentist		3273	SOUTH CAROLINA	No
2	1223S0112X	Dentist	Oral and Maxillofacial Surgery	474	SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ZA9858	MEDICAID	SOUTH CAROLINA
2	U76737	MEDICARE UPIN
3	U767370281	MEDICARE ID-TYPE UNSPECIFIED	SOUTH CAROLINA
4	872701	OTHER		UNITED CONCORDIA
5	88003121	OTHER	ALABAMA	BLUE CROSS BLUE SHIELD
6	ZDK433	OTHER	MASSACHUSETTS	BLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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