=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952528127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINA SMILES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 COUNTRY CLUB RD
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29302-3364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-583-3717
-----------------------------------------------------
Fax | 864-573-6067
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5632
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29304-5632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-583-3717
-----------------------------------------------------
Fax | 864-573-6067
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PHILIP CARLTON MORROW
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 864-583-3717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2508
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------