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General NPI Number Information
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NPI Number | 1447360854
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Entity Type | Organization
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Legal Business Name | CAROLINA CENTER FOR RESTORATIVE DENTISTRY
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 966 SUITE I HOUSTON NORTHCUTT BLVD
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City | MT PLEASANT
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State | SC
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Zip | 29464
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Country | US
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Telephone | 843-849-9044
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Fax | 843-849-7493
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Provider Business Mailing Address
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Address Line | 966 SUITE I HOUSTON NORTHCUTT BLVD
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City | MT PLEASANT
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State | SC
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Zip | 29464
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Country | US
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Telephone | 843-849-9044
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Fax | 843-849-7493
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Authorized Official
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Title or Position | PARTNER PRESIDENT
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Name | DR. KENNETH STEVEN BARRACK
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Credential |
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Telephone | 843-849-9044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 4169621
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 183
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License Number State | SC
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