Provider Demographics
NPI:1801976162
Name:BURTNER, KENNETH M (DMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:BURTNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 BEN CASEY DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8561
Mailing Address - Country:US
Mailing Address - Phone:803-548-9910
Mailing Address - Fax:803-548-9915
Practice Address - Street 1:105 BEN CASEY DR
Practice Address - Street 2:SUITE 115
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8561
Practice Address - Country:US
Practice Address - Phone:803-548-9910
Practice Address - Fax:803-548-9915
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC3553/6111223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9491Medicaid
NC5903373Medicaid
SCZA9491Medicaid