Provider Demographics
NPI:1740547595
Name:CAROLINA FACIAL PLASTICS PLLC
Entity type:Organization
Organization Name:CAROLINA FACIAL PLASTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KULBERSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-906-4761
Mailing Address - Street 1:6849 FAIRVIEW RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3664
Mailing Address - Country:US
Mailing Address - Phone:704-323-5090
Mailing Address - Fax:
Practice Address - Street 1:6849 FAIRVIEW RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3664
Practice Address - Country:US
Practice Address - Phone:704-323-5090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-0220207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty