Healthcare Provider Details

I. General information

NPI: 1639232184
Provider Name (Legal Business Name): CAROLINA ORAL & FACIAL SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 BRENDAN WAY
GREENVILLE SC
29615-3514
US

IV. Provider business mailing address

39 BRENDAN WAY
GREENVILLE SC
29615-3514
US

V. Phone/Fax

Practice location:
  • Phone: 864-458-9800
  • Fax: 864-458-9860
Mailing address:
  • Phone: 864-458-9800
  • Fax: 864-458-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. BART DAVID WILLIAMS III
Title or Position: CEO
Credential: MD, DMD
Phone: 864-458-9800