# CAROLINA ORAL & MAXILLOFACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093848368
- **Authorized official:** KENNETH MARTIN BURTNER DMD (ORAL SURGEON)
- **Authorized official phone:** (803) 548-9910

## Contact information

- **Practice address:** 105 BEN CASEY DR, SUITE 115, FORT MILL, SC 29708-8561
- **Practice address phone:** (803) 548-9910
- **Practice address fax:** (803) 548-9915
- **Mailing address:** 105 BEN CASEY DR, SUITE 115, FORT MILL, SC 29708-8561
- **Mailing address phone:** (803) 548-9910
- **Mailing address fax:** (803) 548-9915

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 3553611 | SC | Yes |

## Other

- **Enumeration date:** 03/14/2007
- **Last updated:** 08/22/2020