MEDICARE: CARNES CROSSROADS DENTAL ARTS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	SC4275	SC

General Provider Information

NPI Number	:	1396981304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARNES CROSSROADS DENTAL ARTS P.A.

Provider Business Mailing Address
First Line	:	3751 S LIVE OAK DR
Second Line	:	SUITE G
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-8746
Country	:	US
Telephone Number	:	843-761-7380
Fax Number	:	843-761-7385

Provider Business Practice Location Address
First Line	:	3751 S LIVE OAK DR
Second Line	:	SUITE G
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-8746
Country	:	US
Telephone Number	:	843-761-7380
Fax Number	:	843-761-7385

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN T. HESS
Credential	:	D.D.S.
Telephone Number	:	843-761-8370

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	12/22/2008

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