Organization
CAROLINA ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH MARTIN BURTNER DMD (ORAL SURGEON)
(803) 548-9910
Entity
Organization
Contact information
Practice address
105 BEN CASEY DR, SUITE 115, FORT MILL, SC 29708-8561
(803) 548-9910
(803) 548-9915
Mailing address
105 BEN CASEY DR, SUITE 115, FORT MILL, SC 29708-8561
(803) 548-9910
(803) 548-9915
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3553611
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5903373
—
NC
05
—
ZA9491
—
SC
05
—
ZX3553
—
SC
Enumeration date
03/14/2007
Last updated
08/22/2020
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