Healthcare Provider Details

I. General information

NPI: 1538595202
Provider Name (Legal Business Name): CAROLINA FAMILY ORTHODONTICS OF FIVE FORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODRUFF PLACE CIR
SIMPSONVILLE SC
29681-3672
US

IV. Provider business mailing address

400 MEMORIAL DRIVE EXT STE 400
GREER SC
29651-1850
US

V. Phone/Fax

Practice location:
  • Phone: 864-284-9466
  • Fax:
Mailing address:
  • Phone: 864-282-1935
  • Fax: 864-851-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number717
License Number StateSC

VIII. Authorized Official

Name: BOBBY MONROE SAFRIT
Title or Position: OWNER
Credential: DMD
Phone: 864-282-1935