Healthcare Provider Details

I. General information

NPI: 1508087586
Provider Name (Legal Business Name): ORTHODONTIC SPECIALISTS OF CAROLINA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HARBISON BLVD SUITE GG
COLUMBIA SC
29212-2222
US

IV. Provider business mailing address

275 HARBISON BLVD SUITE GG
COLUMBIA SC
29212-2222
US

V. Phone/Fax

Practice location:
  • Phone: 803-749-4746
  • Fax: 803-749-9285
Mailing address:
  • Phone: 803-749-4746
  • Fax: 803-749-9285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3358
License Number StateSC

VIII. Authorized Official

Name: DR. KERRY WHITE BROWN
Title or Position: OWNER
Credential: DDS
Phone: 803-749-4746