Provider Demographics
NPI:1689039869
Name:FAIRCLOTH AND BAKEMAN PARTNERSHIP
Entity Type:Organization
Organization Name:FAIRCLOTH AND BAKEMAN PARTNERSHIP
Other - Org Name:AIKEN AUGUSTA ORAL & FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-642-0020
Mailing Address - Street 1:150 CREPE MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7543
Mailing Address - Country:US
Mailing Address - Phone:803-642-0020
Mailing Address - Fax:803-643-5617
Practice Address - Street 1:150 CREPE MYRTLE DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7543
Practice Address - Country:US
Practice Address - Phone:803-642-0020
Practice Address - Fax:803-643-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1223S0112X1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAX ID