Provider Demographics
NPI:1063631711
Name:ORTHODONTIC SPECIALISTS OF CAROLINA, PC
Entity Type:Organization
Organization Name:ORTHODONTIC SPECIALISTS OF CAROLINA, PC
Other - Org Name:KERRY WHITE BROWN, DDS, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-699-9191
Mailing Address - Street 1:224 ONEIL CT
Mailing Address - Street 2:SUITE 13
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7649
Mailing Address - Country:US
Mailing Address - Phone:803-699-9191
Mailing Address - Fax:803-699-5936
Practice Address - Street 1:224 ONEIL CT
Practice Address - Street 2:SUITE 13
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7649
Practice Address - Country:US
Practice Address - Phone:803-699-9191
Practice Address - Fax:803-699-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty