TRIDENT DENTAL ASSOCIATES, LLC
NPI 1053083154
Dentist - Oral and Maxillofacial Surgery in Charleston, SC
About Trident Dental Associates, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TRIDENT DENTAL ASSOCIATES, LLC (NPI 1053083154) is a healthcare organization registered as an oral and maxillofacial surgery in Charleston, South Carolina and active in the NPI registry since September 2021. The organization lists William Tederick Johnson, Group Vice President/ao, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Trident Dental Associates, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Trident Dental Associates, LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Trident Dental Associates, LLC's NPI number?
The NPI number for Trident Dental Associates, LLC is 1053083154. It was assigned to this organization in the NPPES registry on September 28, 2021.
Where is Trident Dental Associates, LLC located?
Trident Dental Associates, LLC is located at 9228 Medical Plaza Dr, Charleston, SC 29406. The listed phone number is (843) 574-5693.
What is Trident Dental Associates, LLC's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.
Is Trident Dental Associates, LLC enrolled in Medicare?
Yes. Trident Dental Associates, LLC is registered in the Medicare PECOS enrollment system.
When is Trident Dental Associates, LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (South Carolina, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Trident Dental Associates, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Trident Dental Associates, LLC, in Dentist and Oral Surgery. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Trident Dental Associates, LLC accept?
Health plans from BlueCross BlueShield of South Carolina list Trident Dental Associates, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Trident Dental Associates, LLC was last updated on August 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Trident Dental Associates, Llc · NPI 1053083154
Oral and Maxillofacial Surgery organization in Charleston, South Carolina. Organization record, active in the CMS NPPES registry since September 28, 2021.
## Identity
- **NPI:** 1053083154 (Entity type: Organization)
- **Enumerated:** September 28, 2021
- **Primary specialty:** Dentist - Oral and Maxillofacial Surgery · taxonomy 1223S0112X
- **Organization subpart:** No
- **Authorized official:** William Johnson, GROUP VICE PRESIDENT/AO
## Practice location
- **Address:** 9228 MEDICAL PLAZA DR, Charleston, SC 29406-9125
- **Phone:** (843) 574-5693 · **Fax:** (843) 764-4512
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, South Carolina, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dentist (1), Oral Surgery (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 29, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1053083154) · Data from the CMS NPPES public registry.