Trident Dental Associates, LLC
NPI 1053083154ActiveOrganization· Dentist, Oral and Maxillofacial Surgery· Charleston, SC
Dentist, Oral and Maxillofacial Surgery in Charleston, South Carolina, registered in NPPES in September 2021. The authorized official on file is William Tederick Johnson, Group Vice President/Ao. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1053083154 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 28, 2021 |
| Last updated in NPPES | Aug 29, 2023 |
| Certified by provider | Aug 29, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Oral and Maxillofacial Surgery Primary | 1223S0112X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (SC) |
|---|
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