Kenneth M. Burtner, DMD

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

3553/611 Issued in SC

Practice address

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

Phone

(803) 548-9910

Fax

(803) 548-9915

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Oms LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Fort Mill, SC
  • NPI 1487345344
  Medicare reassignment NPD
• Carolina Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Mill, SC
  • NPI 1093848368
  NPD (past) Authorized official

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1801976162",
    "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": {
        "last_name": "BURTNER",
        "first_name": "KENNETH",
        "middle_name": "M.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "SC",
            "license": "3553/611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9491",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903373",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan H Bullard, LMSW
• Jay J Burdette, PT
• William Samuel Burns, DMD
• Kristin Nicole Burroughs, MSOT, OTR/L
• Julie Burt, MHS,PT
• Aaliyah Busby
• Raegan Byerley, SLPA
• Narkeya Byrd, LCSW,LISW-CP, MSW
• Cayla Cain
• Lendrianna Cain, RBT

• Oral and Maxillofacial Pathology Dentistry in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Oral and Maxillofacial Pathology Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.