ASHBY PARK PEDIATRIC DENTISTRY EASLEY — NPI 1417309451 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in EASLEY, SC)

CMS-1500 Box 24J / 33a • NPI

1417309451

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1223P0221X

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

708 NORTH A STREET, EASLEY, SC, 29640

Official NPPES Practice Location

Practice Phone & Referral Fax

(864) 605-7741

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1417309451 (ASHBY PARK PEDIATRIC DENTISTRY EASLEY) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1417309451` (NPI-2 Organization / Facility)
Provider / Legal Name	ASHBY PARK PEDIATRIC DENTISTRY EASLEY
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223P0221X` (Dentist, Pediatric Dentistry)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	708 NORTH A STREET, EASLEY, SC, 29640
Practice Telephone / Fax	Tel: (864) 605-7741
Administrative Mailing Address	708 NORTH A STREET, EASLEY, SC, 29640
Enumeration & Last Sync	Enumerated: 2016-07-01 \| CMS Record Updated: 2016-07-01
Authorized Official	JENNIFER GARVEY (Partner/owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

708 NORTH A STREET, EASLEY, SC, 29640

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Plain-English Taxonomy & CMS Crosswalk (1223P0221X)

What Does Taxonomy Code 1223P0221X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223P0221X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ASHBY PARK PEDIATRIC DENTISTRY EASLEY)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223X0400X` — Dentist, Orthodontics and Dentofacial Orthopedics Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: SC \| License: `3638` \| Primary: Secondary
`1223P0221X` — Dentist, Pediatric Dentistry Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: SC \| License: `3638` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ASHBY PARK PEDIATRIC DENTISTRY EASLEY (NPI #1417309451)