Provider Demographics
NPI:1710377866
Name:BAREFOOT ORAL AND MAXILLOFACIAL SURGERY LLC
Entity Type:Organization
Organization Name:BAREFOOT ORAL AND MAXILLOFACIAL SURGERY LLC
Other - Org Name:BAREFOOT ORAL AND FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:REED
Authorized Official - Last Name:BAREFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:843-849-5188
Mailing Address - Street 1:1203 TWO ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7405
Mailing Address - Country:US
Mailing Address - Phone:843-849-5188
Mailing Address - Fax:843-849-5186
Practice Address - Street 1:1203 TWO ISLAND CT
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7405
Practice Address - Country:US
Practice Address - Phone:843-849-5188
Practice Address - Fax:843-849-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty