Provider Demographics
NPI:1316363047
Name:CARNES CROSSROADS DENTAL P.A
Entity Type:Organization
Organization Name:CARNES CROSSROADS DENTAL P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-323-1986
Mailing Address - Street 1:3751 S LIVE OAK DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-7903
Mailing Address - Country:US
Mailing Address - Phone:843-761-7380
Mailing Address - Fax:843-761-7385
Practice Address - Street 1:3751 S LIVE OAK DR
Practice Address - Street 2:SUITE G
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-7903
Practice Address - Country:US
Practice Address - Phone:843-761-7380
Practice Address - Fax:843-761-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty