Provider Demographics
NPI:1447769831
Name:BEAUFORT ORAL AND FACIAL SURGERY, LLC
Entity Type:Organization
Organization Name:BEAUFORT ORAL AND FACIAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:843-525-0900
Mailing Address - Street 1:968 RIBAUT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-8002
Mailing Address - Country:US
Mailing Address - Phone:843-525-0900
Mailing Address - Fax:843-525-0380
Practice Address - Street 1:968 RIBAUT RD STE 3
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-8002
Practice Address - Country:US
Practice Address - Phone:843-525-0900
Practice Address - Fax:843-525-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24521223P0300X
SC89871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty