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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