Carolina Oral & Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3553611 Issued in SC

Legal business name

CAROLINA ORAL & MAXILLOFACIAL SURGERY

Practice address

105 Ben Casey Dr
Suite 115
Fort Mill, SC 29708-8561

Phone

(803) 548-9910

Fax

(803) 548-9915

NPI assigned

Mar 14, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth Martin Burtner, DMDNPI 1801976162

Title

Oral Surgeon

Phone

(803) 548-9910

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth M. Burtner, DMD

  • Oral and Maxillofacial Pathology Dentistry
  • Fort Mill, SC
  • NPI 1801976162
  NPD (past) Authorized official
• Thomas Onley Klauber, MD

  • Diagnostic Radiology Physician
  • Mullins, SC
  • NPI 1659480259
  NPD (past)
• Nicholas Wegner, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Indianapolis, IN
  • NPI 1760919849
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093848368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 BEN CASEY DR",
            "address_2": "SUITE 115",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088561",
            "telephone_number": "803-548-9910",
            "fax_number": "803-548-9915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 BEN CASEY DR",
            "address_2": "SUITE 115",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088561",
            "telephone_number": "803-548-9910",
            "fax_number": "803-548-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BURTNER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "ORAL SURGEON",
        "authorized_official_telephone_number": "803-548-9910",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "3553611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903373",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3553",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9491",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolina Interventional Pain Associates, P.a (Interventional Pain Partners)
• Carolina Interventional Pain Associates, PA (Pain Medicine Specialists of Fort Mill)
• Carolina Medical Partners PLLC
• Carolina Medical Spas PA (Purewellness Spas)
• Carolina Oms LLC
• Carolina Orthopaedic Surgery Associates, P.a.
• Carolina Podiatry Group, Inc.
• Carolina Professional Dentistry,LLC
• Carolina Speech Connection, LLC
• Carolina Speech Works

• Oral and Maxillofacial Surgery (Dentist) in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.