MEDICARE: BAREFOOT ORAL AND MAXILLOFACIAL SURGERY LLC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8483	SC

General Provider Information

NPI Number	:	1710377866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAREFOOT ORAL AND MAXILLOFACIAL SURGERY LLC

Provider Business Mailing Address
First Line	:	1203 TWO ISLAND CT
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7405
Country	:	US
Telephone Number	:	843-849-5188
Fax Number	:	843-849-5186

Provider Business Practice Location Address
First Line	:	1203 TWO ISLAND CT
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7405
Country	:	US
Telephone Number	:	843-849-5188
Fax Number	:	843-849-5186

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW REED BAREFOOT
Credential	:	DDS, MD
Telephone Number	:	843-849-5188

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	01/28/2015

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