Provider Demographics
NPI:1043634363
Name:FAMILY ORTHODONTICS OF S. CAROLINA, LLC
Entity Type:Organization
Organization Name:FAMILY ORTHODONTICS OF S. CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-389-1950
Mailing Address - Street 1:1350 SPRING ST NW
Mailing Address - Street 2:STE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2864
Mailing Address - Country:US
Mailing Address - Phone:404-389-1950
Mailing Address - Fax:678-444-4152
Practice Address - Street 1:712 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7141
Practice Address - Country:US
Practice Address - Phone:843-571-5533
Practice Address - Fax:678-444-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty