MEDICARE: DR. AARON BENTLY CARNER DMD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4089	SC
2	122300000X	Dentist	7598	KY
3	1223P0300X	Periodontics	12680	GA
4	1223P0300X	Periodontics	8355	TN
5	1223P0300X	Periodontics	0401411018	VA
6	1223P0300X	Periodontics	612	SC

General Provider Information

NPI Number	:	1912909631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AARON BENTLY CARNER DMD, MS

Provider Business Mailing Address
First Line	:	110 VENTURE COURT
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-1940
Country	:	US
Telephone Number	:	864-223-0543
Fax Number	:	864-223-3241

Provider Business Practice Location Address
First Line	:	110 VENTURE COURT
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649
Country	:	US
Telephone Number	:	864-223-0543
Fax Number	:	864-223-3241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	09/11/2007

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