Provider Demographics
NPI:1639232184
Name:CAROLINA ORAL & FACIAL SURGERY, P.A.
Entity Type:Organization
Organization Name:CAROLINA ORAL & FACIAL SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BART
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:864-458-9800
Mailing Address - Street 1:39 BRENDAN WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3514
Mailing Address - Country:US
Mailing Address - Phone:864-458-9800
Mailing Address - Fax:864-458-9860
Practice Address - Street 1:39 BRENDAN WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3514
Practice Address - Country:US
Practice Address - Phone:864-458-9800
Practice Address - Fax:864-458-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9824Medicaid
SCF605050281Medicare UPIN
SCZA9824Medicaid