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Organization
CAROLINA CENTER FOR RESTORATIVE DENTISTRY
Active
Organization
CAROLINA CENTER FOR RESTORATIVE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH STEVEN BARRACK (PARTNER PRESIDENT)
(843) 849-9044
Entity
Organization
Contact information
Practice address
966 SUITE I, HOUSTON NORTHCUTT BLVD, MT PLEASANT, SC 29464
(843) 849-9044
(843) 849-7493
Mailing address
966 SUITE I, HOUSTON NORTHCUTT BLVD, MT PLEASANT, SC 29464
(843) 849-9044
(843) 849-7493
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
183
SC
1223P0700X
Prosthodontics
4169621
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45955353
TPIN
—
Enumeration date
08/30/2006
Last updated
09/11/2025
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